"Probable drowning" (SB 1189, Pan & Jackson)

"Undetermined" is  the word used in the official Autopsy Protocol issued by the Coroner Division, San Bernardino County Sheriff's Department, to describe the "manner of death" of Roman Serna Lopez, Jr.

The report tells us some intriguing details as to the manner of death, for instance, that Lopez was found with "his head and torso in the trashcan, with his legs across and on top of the hamper. Lopez had a cloth bag over his head and face." The psychiatric technician who found decedent Lopez in this contorted state "pulled Lopez out of the trashcan and placed him supine on the floor. The cloth bag, which was only loosely around Lopez' head, fell off at that point. Lopez was unresponsive and 911 was called."

How's that, you ask? The autopsy report said that "Lopez had a cloth bag over his head and face." Are we supposed to believe that Lopez put the bag over his own head and face and then took a nose dive into a trashcan? Actually, the facts are even more incredible than that. The autopsy report also says that the trashcan was "filled with 13 inches of water." Are we being led to the possible conclusion that Lopez, whose medical history includes diagnoses of schizophrenia and polysubstance abuse, took a nosedive into 13 inches of water after pulling a cloth bag over his head and face and may have committed suicide in this peculiar manner? The decedent's toxicology screen which included search for cocaine metabolites, amphetamines, opiates, benzodiazepines, fentanyl, and cannabinoids was negative.

The actual examination showed some unusual findings, for example, "a single small petechial hemorrhage in the upper outer quadrant of the of the left sclera" and pulmonary findings showing "marked vascular congestion and alveolar hemorrhage."

There were a "few petechiae found in the sclerae and conjunctivae, consistent with a head down position" plus "acute hemorrhage of tongue."

In the section entitled Diagnosis the first listed diagnosis is "probable drowning." The decedent's body was found "with head inside plastic garbage can with an estimated 13 inches of water." The report adds that the "head was found submerged within the water." There was no evidence of significant blunt force trauma although the decedent's chest showed "mild congestion across the upper chest."

Dr. Trenkle's comment in conclusion was that the cause of death was "probable drowning, minutes." Doctor Trenkle stated that "the cause of death is probable drowning based on the scene description of the decedent being found with his head submerged in water and the absence of another significant competing reason for death."

Witnesses at the autopsy reportedly included Dung Van Tran, MD, and several law enforcement representatives.

My Comment: It is debatable whether or not persons in charge of a decedent's custody while the decedent were alive should be allowed to be present at an autopsy for the person for whose safety during life they were responsible. On the other hand the presence of such personnel is considered desirable if the pathologist or coroner has questions. The theory is that the person doing the autopsy should be able to ask questions that may help establish the manner of death. Law enforcement personnel, by contrast, are not supposed to question the pathologist lest so doing be construed as an attempt to influence the findings.

This issue of The Weinmann Report antedates a scheduled hearing at Senate Appropriations scheduled for later today when Dr. Pan is expected to present with reference to pending legislation, SB 1189 (Pan & Jackson) on this subject. We expect to post again on this matter after the hearing or even if the hearing is delayed. 

AB 2086 (Cooley): deserves passage, vote AYE.

RESTORATION OF NEUROPSYCHOLOGY (AB 2086, Cooley)

In a fit of anti-legislative pique last year, Governor Brown vetoed legislation that had handily sailed though both houses of the legislature. The intent of that legislation was to preserve NeuropsychQMEs. One of the arguments in favor of so doing was that this group of experts was especially well versed in the evaluation of patients with Traumatic Brain Injury (TBI) and had been on-the-job as "licensed health care providers" for 22 years. Their special expertise was applicable for injured workers who sustained cerebral concussions and whose medical plight thereafter became known as post-concussion head syndrome. Since the release of the movie, CONCUSSION, this topic has become a favored conversational subject.

Now comes AB 2086 as an urgency measure sponsored by the California Society of Industrial Medicine and Surgery (CSIMS) and by the California Psychological Association (CPA). The California Neurology Society (CNS) is in support. The California Medical Association (CMA) which submitted amendments which were accepted is neutral on the bill although this writer and others will continue to nudge CMA  for full-fledged support. So far the bill has passed the Assembly Appropriations Committee.

The bill's intent is to restore the right of injured workers with TBI to get workers' comp evaluations from clinical neuropsychologists within the QME (Qualitative Medical Evaluator) framework. Governor Brown's veto last year of AB 1542 (Mathis & Cooley) which would have restored NeuropsychQME status in 2015 instead essentially abolished the NeuropsychQME category at the request of Industrial Relations Director Diane Baker -- at least for the time being. 

AB 2086 seeks to set aside this veto. In making her original recommendation last year Baker overrode the professional opinion of the California Psychology Association. Her reasons for so doing were never well understood but were thought to reflect her desire to maintain departmental authority. Governor Brown, for political reasons still not entirely known, obligingly followed suit. The legislature had the chance to override the veto but declined, preferring to develop new legislation this year. That is the basis for AB 2086.

The wisdom of this choice is that AB 2086 amends current law so that once passed it'll no longer be possible for Industrial Relations directors to obstruct the neuropsych evaluation process by refusing to recognize NeuropsychQMEs. It would "ensure that lack of official Medical Board of California (MBC) recognition cannot be used as grounds to not appoint certain physicians as QMEs" and for the purposes of QME designation that those specialties recognized by the administrative director would be recognized. 

References

California Medical Association Legislative Hot List, 4/26/16

The Weinmann Report, www.politicsofhealthcare.com, 10/15/15

Will the Gov. Avoid a Collision in Health Care Policy?,  workcompcentral, 10/07/15, by Dr. Robert Weinmann

Gov's. Veto of AB 1542 Leaves Brain-injured Workers to Fend for Themselves, workcompcentral, 10/09/15, by Steve Cattolica, AdvoCal/CSIMS

Neuropsych Bill Headed to Governor, CSIMS, 9/01/15

ADDENDUM, 7 MAY 2016

On 28 April 2016 the California Assembly passed AB 2086 by 76-0. The authors are Ken Cooley, D-Rancho Cordova, and Devon Mathis, R-Visalia. If signed into law the bill would become effective immediately. The bill has been introduced to the State Senate. We do not have information so far on committee assignment. Remember that last year Governor Brown vetoed a similar bill that handily passed both houses of the legislature.