Forensics of an Epidemic

Karl Williams shows what we can learn from the deaths
Fall 2016

Williams (right) on the job as Allegheny County medical examiner.

In January 2014, a spate of fatal overdoses in Western Pennsylvania sent 17 bodies to the Allegheny County Medical Examiner Facility, run by Karl Williams (MD ’74, MPH ’03). One clue seemed to link the deaths—small packets of heroin, known as “stamp bags” on the street, branded “Theraflu”by the dealer.

Within three weeks, Williams and his staff had linked autopsy, toxicology, and crime scene evidence to those designer packets and issued a public health warning urging heroin users to beware of the deadly mix of fentanyl and heroin they contained. “Because I was getting bodies, blood, and stamp bags, I could put together a running tally and make it public knowledge—not only what was killing people, but also what stamp bags it was in,” says Williams, who credits members of his toxicology and drug chemistry teams for their roles in the case.

Williams also credits a unique feature of the Medical Examiner Facility, the first accredited crime lab in Pennsylvania, which he has overseen since it opened in 2009. In most parts of the United States, crime scene evidence, bodies, and fluid samples from a single case each take a distinct path through the chain of custody, with medical examiners, police, and distant toxicology labs each operating in isolation. It can take weeks or even months for the resulting reports to make their way back through the investigative food chain.

Not so in Allegheny County, where the $26.8 million Medical Examiner Facility—an 80,000-square-foot building in Pittsburgh’s Strip District—puts pathologists, toxicologists, ballistics experts, and other scientists under the same roof. Under Williams’s leadership, the team investigates well over 1,000 deaths annually, including those of anyone who dies accidentally, suddenly, unexpectedly, or outside of a doctor’s care. In 2015, 451 people died due to natural causes in the county; there were also 116 homicides and 179 suicides.

But nothing compares to the accidental overdoses (attributable to 424 deaths last year), the vast majority of which feature opioids—heroin, fentanyl, and their ilk (see our feature story on p. 24). Unlike motor-vehicle accident fatalities, which have plummeted in the past two decades because of improved vehicle engineering and seat belt use, fatal overdoses have climbed precipitously. In Pennsylvania, drug overdose deaths have increased 14-fold in the last 35 years. “The number of opioid overdose deaths nationwide is getting very close to the total number of Americans killed as a result of the Vietnam War,” says Williams. “That’s a mind-boggling statistic.”

To help public health officials wrap their heads around those numbers—and optimize interventions—Williams has dedicated himself to making data on overdose deaths in Pennsylvania freely available. He takes pride in OverdoseFreePA.pitt.edu, an online collaborations Pitt’s School of Pharmacy with a half-dozen nonprofit organizations and 16 communities.

“It’s my belief that that information is essential to trying to deal with the problems,” says Williams, who also serves on the Allegheny County Overdose Prevention Coalition’s executive committee. “The people at the ground level—working on resources for education, treatment, and prevention—they need an idea of the numbers involved.”

Drug trends differ by county, says Williams, pulling up the OverdoseFreePA website and clicking on the data tab. “You can see gender, age, top 10 drugs, even [view the data] by zip code where [overdoses] are happening,” he says. “It’s different in each county in terms of age, sex, distribution.” Allegheny and neighboring Westmoreland Counties currently make their data available through the site. Over time, Williams hopes to recruit other counties. It’s an uphill climb, he notes, because most coroners in Pennsylvania are funeral directors without medical degrees and have very limited resources for toxicology analyses. “This is the single-most important public health issue of my career,” says Williams, “and I have the ability to generate a really unique data set.”

 

 


Robert Sanders: Of Sea and Space

BY LIBERTY FERDA

Sanders at NASA's Neutral Buoyancy Laboratory

As 100-mile-an-hour winds blasted across the frozen landscape, Robert Sanders (Res ’08) waited out the storm with five other researchers. “If our hut failed, we were dead,” he recalls of that time in Antarctica. Still, he didn’t regret coming. The skilled diver had been tapped by the New York Department of Health just out of college for the mission; and in the waters among icebergs he went on to catalog 12-inch sea spiders, swimming scallops, and creatures known as Astrammina rara—single celled carnivores that secrete a biological superglue.

“That learning was so enjoyable that it helped set me on the path for med school,” he says. An avid diver since age 14, he gained expertise that led to adventures galore. An advocate for scuba diving safety and emergency care, he later worked for the films Cast Away and Stuart Little, for the Los Angeles County Sheriff’s Department, and on Catalina Island, a diver’s paradise 22 miles off the LA coast. He helped divers avoid potentially fatal illnesses like decompression sickness and air embolism.

Sanders realized becoming a doctor would offer even more scientific adventures and opportunities to ensure diver health, so he went to med school at Rosalind Franklin University in Chicago, then did an emergency medicine residency at Pitt. While in Pittsburgh, he trained river rescue teams.

Today he’s in charge of the NASA medical team’s Neutral Buoyancy Laboratory in Houston, a 6 million–gallon swimming pool with a mock-up of the International Space Station (ISS) on the floor. Astronauts train there, lowered in by crane while wearing full space gear, to rehearse station repairs and other tasks in this simulated zero gravity environment.

As medical director and crew health and safety flight surgeon, Sanders oversees the safety crew and operates the hyperbaric chamber. He supervised aspects of training for Scott Kelly prior to the astronaut’s groundbreaking yearlong mission on the real ISS to study the human body’s reaction to long-term space travel.

Though Sanders still dives around the world, frequently taking his daughter to her favorite snorkeling spots in the Caribbean, he’s hoping for his biggest plunge yet: Perhaps, one day, a trip to space?

 

Photo courtesy NASA, William Brassard

SaveSave

SaveSave

SaveSave