Pilot project has coroners investigate all nursing home deaths

December 9th, 2008 by Jennifer Walker-Journey

John Whalen visited 87-year-old Bernice Mulch weekly at a Jacksonville, Ill., nursing home. Whalen, who had legal authority over the woman’s care, had no reason to believe that his friend was not getting adequate care. After she passed away, the Morgan County coroner investigated her and determined that that Mulch’s was caused by a staff member’s failure to follow doctor’s orders to give her antibiotics for an arm infection. As a result, the was fined $10,000 by the state, according to the State Journal-Register.

When Whalen learned that his friend’s was being investigated, he assumed it was protocol for all deaths to be investigated by coroners. However, in Illinois are not required to report deaths of patients in their care to the coroner’s office. Doing so would enable the coroner to investigate the deaths for possible or .

Morgan County coroner Jeff Lair has made investigating all deaths that occur in in his county a policy, and believes a law should be passed so that all in his state must report patient deaths to their local coroners.

Only the states of Arkansas and Missouri require to report patient deaths for potential investigation. This law spurred the Illinois Department of Public Health to enact a year-long pilot project in 10 Illinois counties – including Lair’s – where all deaths were reported to coroners. The pilot project was completed last summer. During that time, 3, 669 deaths were investigated and in eight of those, coroners reported suspicious circumstances surrounding the deaths.

Despite the results, it is unlikely a law will be passed in Illinois requiring in the state to report patient deaths. The public health department said legislation would have to be spearheaded by the Illinois Coroners and Medical Examiners Association. And that association said the results just simply were not sizeable enough and likely the law would not come with much-needed funding to carry out the practice statewide.

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