Casino-related deaths in Atlantic City, New Jersey 1982-1986

The first legalized casino-hotel opened in Atlantic City, New Jersey in 1978. Annually, more than 30 million people visit the "Gambling Capitol of the East Coast." As a result of this growing influx of people, the Atlantic County Medical Examiner's Office began compiling statistics in 1982 of casino-related deaths. Data on 398 casino-related deaths occurring in 1982-1986 were collected and analyzed: 83% of the total number of fatalities were sudden cardiac deaths. Most of the victims were elderly white retired men who had previously diagnosed medical conditions. Many of the victims' underlying medical problems are of a type known to be associated with compulsive gambling. The majority of deaths occurred during the afternoon hours on weekends in October, January, and May. Of the victims, 86% were from New Jersey, New York, and Pennsylvania. For Atlantic City, a gambling community known to have a relatively high rate of crime and drug-trafficking, only 1% of all deaths were homicides. We speculate that the stress of gambling activities may induce sudden cardiac death. We therefore recommend that communities planning to legalize casino gambling mandate that gambling establishments provide emergency health care services for their patrons.     

An ecological study of factors associated with rates of self-inflicted death in prisons in England and Wales

This study describes ecological associations between self-inflicted death rates and prison-level environmental indicators over the period 2000-2002 in England and Wales. The objective was to assist in the development of interventions for reducing the incidence of self-inflicted deaths in prisons in England and Wales, by identifying risk factors, including overcrowding, positive drug tests, the number of assaults, purposeful activity, offending behaviour programmes, and cost per prisoner. Poisson regression was used to estimate associations between self-inflicted death rates and these potential risk factors, controlling for different categories of prison. The annual rate of self-inflicted death during 2000-2002 was 1.14 per 1000 (95% CI 0.98 to 1.34), with no evidence for a difference in the two years. Highest rates were in the Male Local and Women's prisons at 1.86 (95% CI 1.42 to 2.26) and 2.27 (95% CI 1.35 to 3.84) per 1000 respectively. In a multivariate analysis, overcrowding, assault rate and purposeful activity were significant. In an analysis controlling also for prison category, only purposeful activity remained independently significant, as a protective factor (RR 0.57, 95% CI 0.35 to 0.92, p=0.02) with weaker evidence for a positive association with positive drug tests (RR 1.41, 95% CI 0.96 to 2.05, p=0.08). Despite concerns about the quality of routinely collected data and the interpretation of ecological associations, this study suggests that a higher level of purposeful activity is independently associated with lower rates of self-inflicted death, whatever the prison category. This adds support to other studies conducted at the level of the individual prisoner.     

THE RACE/ETHNICITY DISPARITY IN MISDEMEANOR MARIJUANA ARRESTS IN NEW YORK CITY

RESEARCH SUMMARY: This article examines the growth in marijuana misdemeanor arrests in New York City (NYC) from 1980 to 2003 and its differential impact on blacks and Hispanics. Since 1980, the New York City Police Department (NYPD) expanded its use of arrest and detention for minor offenses under its quality-of-life (QOL) policing initiative. Arrest data indicate that during the 1990s the primary focus of QOL policing became smoking marijuana in public view (MPV). By 2000, MPV had become the most common misdemeanor arrest, accounting for 15% of all NYC adult arrests and rivaling controlled substance arrests as the primary focus of drug abuse control. Of note, most MPV arrestees have been black or Hispanic. Furthermore, black and Hispanic MPV arrestees have been more likely to be detained prior to arraignment, convicted, and sentenced to jail than their white counterparts. POLICY IMPLICATIONS: In light of the disparities, we recommend that the NYPD consider scaling back on MPV enforcement and reducing the harshness of treatment by routinely issuing Desk Appearance Tickets when the person is not wanted on other charges, so that most MPV arrestees would not be detained. Furthermore, we recommend that legislators should consider making smoking marijuana in public a violation and not a misdemeanor. Lastly, we suggest ways that NYC could monitor the effectiveness of these policy modifications to assure that the city continues to meet its goals for order maintenance.     

Drug and alcohol use as determinants of New York City homicide trends from 1990 to 1998

In this population-level study, we analyzed how well changes in drug and alcohol use among homicide victims explained declining homicide rates in New York City between 1990 and 1998. Victim demographics, cause of death, and toxicology were obtained for all homicide (N = 12573) and accidental death victims (N = 6351) between 1990 and 1998 from the Office of the Chief Medical Examiner of New York (OCME). The proportion of homicide and accident decedents positive for cocaine fell between 1990 and 1998 (13% and 9% respectively); the proportion of homicide and accident decedents positive for opiates and/or alcohol did not change significantly. Changing patterns of drug and alcohol use by homicide victims were comparable to changing patterns of drug and alcohol use in accident victims, suggesting that changes in drug and alcohol use among homicide victims between 1990 and 1998 cannot solely explain the decline in NYC homicide rates.     

Schizophrenia as a cause of death

Schizophrenia is a chronic disorder that is associated with increased mortality. Although traumatic deaths account for most of this increase, there is also an increased rate of natural deaths in this population. Altered autonomic physiology in this group might contribute to death. To determine if there are schizophrenics in whom, after a complete autopsy, no recognizable cause of death other than schizophrenia is established, the records of the Office of Chief Medical Examiner of the City of New York were reviewed for deaths associated with schizophrenia and a natural manner of death. Six such decedents were identified, and their histories and autopsy results are described. We believe that schizophrenia per se is a potentially lethal disorder. Autonomic irregularities and their interactions with psychotropic drugs deserve further attention.     

Ten years of "body packers" in New York City: 50 deaths

We reviewed all 50 body packer deaths in New York City from 1990 to 2001. The majority (37/50) of deaths were caused by acute intoxications due to open or leaking drug packets in the gastrointestinal tract. The number of packets recovered ranged from 1 to 111 (average 46). The weight of the combined packets ranged from 9.4 to 1,200 g (average of 377). The age ranged from 19 to 57 years (mean 37.1). The decedents were: 82% male, 66% Hispanic, 24% Black, and 10% White. The manners of death were 47 accidents, 1 homicide, 1 natural, and 1 undetermined. The causes of death included 42 acute intoxications, 5 intestinal obstructions/bowel perforations, 1 gunshot wound, 1 intracerebral hemorrhage due to hypertensive disease, and 1 undetermined. Of the 50 decedents, 42 were transporting opiates, 4 cocaine, and 4 both opiates and cocaine. There were 9 deaths from 1990-1995 and 41 from 1996-2001. Of the 41 deaths between 1996 and 2001, only 6 involved cocaine. In New York City there has been an increase in body packer deaths from the early 1990s to the late 1990s. Along with this increase is a marked predominance of opiate body packer deaths with few cocaine deaths.     

The rise and rise of fentanyl in postmortem casework

Forensic toxicology laboratories are navigating a period of time with increasing drug overdose deaths, an opioid epidemic, the impact of the COVID-19 pandemic, and the illicit drug market flooded with novel psychoactive substances. In New York City, the Department of Forensic Toxicology has experienced a 56% increase in postmortem casework in the past decade with fentanyl detected in 80% of all overdose deaths. Over a period of 2.5 years, 15,638 postmortem cases were tested for the presence of fentanyl and fentanyl analogs using liquid-chromatography tandem mass spectrometry (LCMSMS). Fentanyl was detected in approximately one third of cases and of these 4447 cases with femoral blood. A twofold increase in cases with high concentrations of fentanyl (>100 ng/mL) was observed between 2021 and 2022. The minor metabolite and precursor chemical, 4-ANPP (4-anilino-N-phenethylpiperidine) may help differentiate between illicit and licit fentanyl. 4-ANPP blood concentrations were <10 ng/mL in 98% of the cases and the 4-ANPP:fentanyl ratio was <0.67 for 99.1% of blood specimens. Only six cases had 4-ANPP concentrations higher than the corresponding fentanyl blood concentration. This study also highlights, the changing fentanyl analogs found in postmortem cases since 2016 in NYC with the emergence of fluorofentanyl initially identified in 2020 and continuing to dominate in comparison with the prevalence of other analogs, many of which are no longer detected in casework. The detection of one of the latest drugs to be mixed with fentanyl, namely xylazine, has also increased in prevalence by 36.7% in 2022 compared with 2021.     

Medicolegal investigation in New York City. History and activities 1918-1978

Medicolegal investigation in America can truly be said to have begun in an organized manner in 1918. The Massachusetts medical examiner system, which began in 1877, never developed with the central control and the completeness that characterizes the New York Office of the Chief Medical Examiner, nor did it influence the spread of this form of medicolegal investigation. An overview of the period before the establishment of the New York Office in 1918 and early experiences in coroner's investigation in New York is presented. The roots of the development of the office are discussed, as were the early days of the office under Dr. Charles Norris, whose influence on the spread of knowledge and of providing an important service to the community in general is detailed. The contributions of Alexander Gettler, the father of forensic toxicology in America, are also discussed. The contributions of Gonzales, Vance, Helpern, Umberger, and Wiener are also included. Special problems of New York City are described, including narcotic deaths, gas refrigerator deaths, malaria in addicts, plastic bag hazards, sudden infant deaths, operative deaths, as well as many famous cases involving murder, disasters, and unusual deaths over a period of 60 years. Milestones in the Office of the Chief Medical Examiner of New York City are listed, as are chronological details of major cases and problems. Several comparative figures of the workload and frequency of various types of death are also included. A relationship of deaths to different life-styles is noted.     

A Retrospective Study of Intentional Body Dismemberment in New York City: 1996–2017

A review of New York City dismemberment cases occurring between 1996 and 2017 was conducted, which resulted in a total of 55 dismembered decedents in a 22‐year period. Annual trends indicate an average of 2.5 dismembered decedents. Additional results show that 53% of cases involved transection only, 35% involved disarticulation only, and 13% involved a combination of both. When the entire body could be accounted for, the average number of body portions per case was 5.5. Frequent locations for dismemberment were the neck, shoulders, hips, and knees. Dismemberment locations showed a general trend of anatomical symmetry. Seventy‐eight percent of the dismemberments involve disposal of body parts in an outside location. Eighty‐four percent were concealed from view with some type of covering. The findings from New York City are compared with other studies.     

“Bath Salts” the New York City Medical Examiner Experience: A 3‐Year Retrospective Review

“Bath salts” are synthetic derivatives of cathinones, compounds found in the leaves of Catha edulis, which possesses amphetamine‐like properties. At the New York City Office of Chief Medical Examiner, we conducted a 3‐year retrospective analysis of deaths in which cathinones were detected. Two categories emerged; those in which cathinones were a contributory cause of death (15 cases) and those in which they were an incidental finding (15 cases). Of the former group, 13 were associated with additional intoxicants; two deaths were attributed solely to cathinone intoxication, both survived 10 h: a man whose postmortem blood methylone concentration was 0.71 mg/L and a woman whose postmortem blood ethylone concentration was 1.7 mg/L. In the latter category, there were several individuals who had higher concentrations of cathinones than the above two, the highest being a blood methylone of 4.8 mg/L. Based upon our data and the literature presented, lethal concentrations of cathinones cannot be established.     

Administrative interventions on police shooting discretion: An empirical examination

In August, 1972, the New York City Police Department promulgated administrative shooting guidelines and shooting incident review procedures far more restrictive than former statutory “defense of life” and “fleeing felon” justifications for police shooting. Using a data base that includes all reported New York City police firearms discharges and serious assaults on police between 1971 and 1975, this article examines the effects of the new guidelines and procedures on shooting frequencies, patterns, and consequences.Great decreases in “fleeing felon” shootings, “warning shots,” and shooting-opponent injuries and deaths were found to be associated with the new rules. This change also appeared to have a favorable effect on line-of-duty officer deaths and serious injuries. The implications of these findings are discussed.     

Toxicological findings in victims of traumatic deaths.

The toxicological findings from 6037 analyses of viscera obtained from victims of traumatic death are used to correlate the relative incidence of carbon monoxide, ethyl alcohol, narcotics, hypnotics, analgesics, and tranquilizers-antidepressants in deaths occurring under the following circumstances: fire related, asphyxia by hanging, by use of plastic bags, from physical obstruction of trachae, and by drowning; traumatic injury from impact of moving train, fall from height, and occupational accident; traumatic injury to pedestrian, driver, and passenger from vehicular accidents; and from violent death by shooting, stabbing, strangulation, and beating. The influence of alcohol, narcotic drugs, and tranquilizers on carbon monoxide can be seen in some of these traumatic deaths. Ethanol alone and in combination with other drugs was present in 42.3% and 19.5% of driver and pedestrian victims, respectively, of vehicular accidents in the year 1974. Comparative analysis is presented for the toxicological data obtained on victims of homicide (shooting, stabbing, strangulation, and beating) in New York City and similar data reported for victims of homicide in Detroit. In New York City 45.9% of such victims died while under the influence of alcohol or narcotic drugs, or both, with methadone predominating in the latter category. Tissue concentrations of drugs found in victims of traumatic death are presented. Diphenylhydantoin, diazepam, meperidine, and slow-acting barbiturates were found in normal therapeutic levels. Higher concentrations of amitriptyline, chlorpromazine, propoxyphene, short-acting barbiturates, and methadone were observed. The concentration of methadone in blood and brain (0.13 +/- 0.14 mg/100 ml) and in liver (0.53 +/- 0.42 mg/100 ml) in cases of traumatic death are not different from those observed in deaths classified as due to methadone overdose.     

Ketamine in non-hospital and hospital deaths in New York City

We reviewed all ketamine-positive deaths (87) examined at the New York City Office of Chief Medical Examiner over a two-year period (1997 to 1999). There were 15 non-hospital deaths with 12 due to acute multidrug intoxications, one due to sarcoidosis, and two due to physical injury (blunt and thermal). In no instance was a fatal intoxication caused exclusively by ketamine. Opiates (10/15), followed by amphetamines (7/15) and cocaine (6/15), were the most frequent co-intoxicants. Ethanol was found in only one death. The race of all decedents was white and the majority were men (11/15) between the ages of 18 and 30 years. The remaining 72 instances of positive ketamine findings were hospital deaths following surgical procedures or burns.     

Race/Ethnic-Specific Homicide Rates in New York City: Evaluating the Impact of Broken Windows Policing and Crack Cocaine Markets

The current study evaluated a range of social influences including misdemeanor arrests, drug arrests, cocaine consumption, alcohol consumption, firearm availability, and incarceration that may be associated with changes in gun-related homicides by racial/ethnic group in New York City (NYC) from 1990 to 1999. Using police precincts as the unit of analysis, we used cross-sectional, time series data to examine changes in Black, White, and Hispanic homicides, separately. Bayesian hierarchical models with a spatial error term indicated that an increase in cocaine consumption was associated with an increase in Black homicides. An increase in firearm availability was associated with an increase in Hispanic homicides. Last, there were no significant predictors for White homicides. Support was found for the crack cocaine hypotheses but not for the broken windows hypothesis. Examining racially/ethnically disaggregated data can shed light on group-sensitive mechanisms that may explain changes in homicide over time.     

Cocaine and fetal death

Toxicologic screening for cocaine and its metabolites was performed on 103 cases of fetal death autopsied in the Office of Chief Medical Examiner, City of New York. In 64 cases cocaine or its metabolites were found in the blood or in the brain. Some malformations were also found. The study indicates that maternal use of cocaine may lead to abruptio placentae, abortion and fetal death. The importance of toxicologic examination in these deaths is emphasized.     

Mortality in cerebral palsy (CP): the importance of the cause of CP on the manner of death

Cerebral palsy (CP) is a nonprogressive motor deficit present or sustained in the perinatal period. We reviewed the files of the Office of Chief Medical Examiner of the City of New York for the 1997-2001 interval seeking those with any mention of cerebral palsy. There were 26 such cases, including 18 natural deaths, three accidents, two homicides, two therapeutic complications, and one death classified as undetermined. Proper reporting and careful investigation of these deaths is required for accurate certification of cause and manner of death, as well as for adequate tracking of these deaths for public health purposes.     

Analysis of cocaine-positive fatalities

A review of all autopsy and toxicology reports for persons dying in New York City in an 11-month period found 935 persons dying with cocaine in their bodies. Cocaine-positive fatalities were more likely in the young black and Hispanic and male population. In addition to cocaine and its metabolites, heroin and other opiates were found in 39% of persons and ethanol in 33% and barbiturates and minor tranquilizers in only 2% of the deceased. Cocaine overdose was responsible for 4% of the deaths and overdose with heroin and cocaine for 12% of the deaths. Violence was often the cause of death. Thirty-eight percent died of homicide, seven percent of suicide, and eight percent from accidents. Of particular interest were 6 persons who died of acute cardiac events directly related to cocaine as well as 4 cases of ruptured dissections of the ascending aorta, and 9 cases of cerebral hemorrhage. Autopsy findings for these individuals are described, and possible mechanisms of death are discussed.     

Phencyclidine: a 5-year retrospective review from the New York City Medical Examiner's Office

We report here a 5-year retrospective review of autopsy cases from the New York City Medical Examiner's Office that demonstrated phencyclidine (PCP) in the blood. There were a total of 138 cases. There were 52 deaths because of mixed drug intoxication: the blood PCP concentrations in these cases ranged from <1 to 598 ng/mL. There were 80 violent deaths in which PCP was quantified in the blood but was unrelated to the cause of death. There were five nonviolent deaths in which PCP exclusively was detected. In four of these, there were preexisting medical conditions that could also have contributed to death. In these, the highest PCP concentration was 361.3 ng/mL, a concentration lower than seven of the individuals in our violent death category. This suggests that lower concentrations may be fatal with comorbid conditions.     

THE IMPACT OF ORDER‐MAINTENANCE POLICING ON NEW YORK CITY HOMICIDE AND ROBBERY RATES: 1988‐2001*

Local officials and national observers have attributed the New York City drop in violent crime during the 1990s to the aggressive enforcement of public order, but relevant research is limited and yields contrasting conclusions regarding the effects of order‐maintenance policing (OMP) on violent crime trends in New York City. The current study investigates the effects of order‐maintenance arrests on precinct‐level robbery and homicide trends in New York City with more reliable crime and arrest data, longer time series, and more extensive controls for other influences than used in prior research. We find statistically significant but small crime‐reduction effects of OMP and conclude that the impact of aggressive order enforcement on the reduction in homicide and robbery rates in New York City during the 1990s was modest at best.     

Gunshot fatalities in children and adolescents in New York City

We reviewed the case records of all fatalities due to gunshot wounds in children and adolescents under 19 years of age in New York City from 1996 to 2000. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 263 deaths: 242 homicides, 17 suicides, and 4 accidents. Among the homicides, 96% involved Black or Hispanic and 68% involved 17 and 18-year-old decedents. There were 11 times as many male as female homicides. The detection of ethanol and/or illicit drugs was 56% in the homicide and 53% in the suicide groups. Suicide notes were found in 18% of suicides, and an additional 35% verbally expressed a plan to commit suicide. Most suicides (77%) were in the home and half of the homicides occurred on the street.