Commonwealth Media Services
Charles Thompson/PennLive
The Pennsylvania Department of Health has heard the complaints from coroners around the state about how it is collecting and reporting data on the coronavirus pandemic, but it is standing by its system.
Coroners – who are elected at the county level to investigate and determine cause and manner of death in sudden, violent or other unnatural deaths, or deaths that occur outside medical treatment settings – have argued in recent days that data collection would occur more efficiently and accurately if COVID-19 deaths were reported to them, and then they funneled that data to the state.
There are parallel concerns that the state is in some ways “bigfooting” them, since, by their reading of Pennsylvania’s County Code, they have a duty to investigate when a death is “known or suspected to be due to contagious disease and constituting a public hazard.”
There are practical considerations about cutting coroners out of the loop, too, added Susan Shanaman, solicitor to the Pennsylvania Coroners Association. “The people in any given county generally will reach out to the coroner (as a locally elected official) for updates on how bad the pandemic is in their county,” she said Tuesday. “They’re not going to call the Department of Health.”
Here’s what the Department of Health had to say in response to the questions being raised.
Responses here came from Health Department Press Secretary Nate Wardle, though it’s worth noting that at a Wednesday evening press briefing state Health Secretary Dr. Rachel Levine said her staff will continue to hold conversations to try to strike a better “balance” with county coroners going forward.
“We will work with the coroners to make sure that we reconcile our of data, and that we’re all on the same page,” Levine said during the briefing.
Q: Why are you requiring all COVID-19 cases to be reported by attending doctors directly to DOH, and bypassing county coroners?
A: The department believes that the current structure of handling deaths, where medical professionals handle deaths in which they attend to, is appropriate.
This is what happens for other diseases, such as the flu. Deaths are referred to a coroner if a death case occurs when a medical professional is not able to certify the death, or if the circumstances surrounding the death suggest the death was sudden, violent, suspicious in nature or was the result of other than natural causes.
In addition, the Disease Prevention and Control Act requires reporting of disease data to the department at all times, regardless of if it is during a pandemic. We have the authority to set the data points for the report.
In many cases, it must be noted, local hospitals and doctors are sharing their reports with the county officials, too.
Q: What about the language in Pennsylvania’s County Code that states it is the coroner’s duty to investigate contagious disease cases that could constitute a public hazard? Isn’t this in conflict with that?
A: The Coroner’s Law in the county code comes into play when the coroner views the body. If the death is attended to by a medical professional, the coroner would not see the body. The coroners only have authority if the death case is referred to them, which again occurs if the death is not witnessed, or if it sudden, violent or suspicious.
A death associated with COVID-19 would not be sudden, violent or suspicious, and in most cases would occur in a health care setting. Again, flu is an infectious and contagious disease, and coroners do not investigate flu deaths.
Q: Coroners say there are discrepancies between the numbers of COVID-19 deaths they’ve received notice of and what the state is reporting for their counties.
Franklin County Coroner Jeff Conner, for example, told PennLive Wednesday he’s had notice of four COVID-19 deaths with positive tests (only one of which was a Franklin resident), while the state’s count for Franklin County is at 10. “True numbers are important to know where we really stand,” Conner said. “When it comes to regional reopening it matters a lot if we are one (death) or ten. One would we were in fair shape. Ten might give them a reason to not allow this area to open.”
Why is this happening, and how concerned should we be about accuracy of the data?
A: As we collect data, we also are verifying its accuracy and that can create a time lag in public reporting.
For example, some deaths are reported to us with several causes of death and COVID-19 is listed as the fourth or fifth cause of death. Our epidemiologists then investigate whether or not that person had previously tested positive for COVID-19 or lived in a setting like a nursing home where there are other people are known to have the virus.
There are some discrepancies, but we believe that as we move forward those discrepancies will be worked through and will not continue to be issues.
(Wardle did not address the specific discrepancy in Franklin County.)
Q: Coroners are also stating that many doctors had not routinely used the state’s Electronic Death Reporting System prior to this pandemic, and their lack of familiarity with the system is a needless time-suck as they try to battle the infection. Are you concerned about the professionals’ readiness to use the EDRS and its functionality?
A: Our notices go step by step into how to sign up for an account to report to EDRS. We have seen thousands of individuals sign up recently, and do not view it as a problem. We believe that the electronic reporting is the fastest and most-efficient way for information to get to DOH.
Q: Some coroners are also questioning listing deaths with the county of residence. In one case, for example, a Pennsylvanian who died in Idaho, where the person maintained part-time residence, was listed as a death in Sullivan County. Why are you doing that? Coroners argue it’s most important to contact-trace where the person was, as opposed to where they lived?
A: This is nothing new for how things are handled in regard to infectious diseases in Pennsylvania, or around the country as this is how infectious disease cases are handled across the country. In most cases, because of COVID-19?s incubation period, the place of residence is just as important as the place of death, which may simply be a medical facility in a neighboring county.
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