Anne (not her real name) was lying at the bottom of the stairs, unconscious, face bloodied, when EMS responded to her boyfriend’s 9-1-1 call. Anne had a history of alcoholism and depression. Police confirmed she was also the victim of previous domestic violence incidents. On admission to the hospital, she had multiple facial fractures, brain swelling, and a very high blood alcohol level. The boyfriend claimed he’d found her like that. Anne’s family insisted it was murder. It was up to the coroner — me — to decide. Was this fall an accidental death or a homicide?
The Coroner’s Dilemma
A body at the bottom of a staircase. It’s a crime fiction trope for a reason. Falls are a leading cause of accidental death, but excluding homicide can be a challenge. Even sophisticated forensic analysis of injuries and blood spatter don’t always provide an answer. Investigators can’t always relay on interviews of someone on the scene or close to the victim. If alcohol or drugs are involved, as is often the case, both the cause and manner of death become more difficult to determine.
Netflix’ true crime docuseries The Staircase is about a fall-related death. The series covers years of investigation and two criminal trials that ended in hung juries. The director of the docuseries admitted that even he wasn’t sure if the husband, who happened to be a crime novelist, was guilty or innocent of murder.
Anne’s death was just as puzzling. After extensive studies, there wasn’t enough evidence to decide between accident or homicide. I ruled the manner of death undetermined. Meanwhile, the boyfriend who’d called 9-1-1 was nowhere to be found — rumor had it that he’d left the state. Because I had not ruled the manner of death a homicide, the police dropped the case.
Accidental fall deaths in the construction industry
Do a search using the term “fatal falls” and you’ll get endless hits for a video game featuring falls from “the sheer cliffs of the island’s coast.” Sounds terrifying, but at least you can play the game and walk away. The same wasn’t true for the 351 workers who died in a fatal construction site fall in 2020.
Falls are the leading cause of accidental death in the construction industry. Coroners call the local Occupational Safety and Health Administration (OSHA) for any workplace death. OSHA is very transparent with its data. Decedent names, locations, company names, and descriptions of each fatal event are on its user-friendly workplace fatalities website. Using what it learns from these tragic events, OSHA puts extensive effort into industry-specific fall prevention programs.
Falls: underreported accidental deaths in the elderly
More than 42,000 people in the US died a fall-related death in 2020. More than 86% of them were 65 years or older.
Falls are the leading cause of accidental death in the elderly. They are also the least likely to get a full medicolegal death investigation.
In 2020, just as many people died from falls as from drug overdose deaths in Chester County, PA. There were 108 drug intoxication deaths, a 4% increase from 2019. Most of those were in the 25-54 age groups. But there were also 107 fall deaths, a whopping 40% increase from 2019. Almost all the fall deaths were in people over 65 years of age.
Long-term care facilities almost certainly under-report fall-related deaths. Nursing home physicians (usually called medical directors) may sign death certificates for deceased residents without seeing the body. They may not even have seen the patient for a month or longer. Unless a funeral director sees something of concern on the body, or family reports a recent trauma , most deaths are certified as due to natural causes. As a result, fall-related deaths are often missed.
In 2019, Pennsylvania state legislators introduced bills mandating reporting of every nursing home death to the county coroner. That year Scott Grim, former Lehigh County coroner and currently Executive Director of the PSCA, was quoted as saying: “I’m a firm believer that all nursing home deaths and assisted living facility deaths – whether they are natural or not – are reported to the coroner’s office just to make sure everything is appropriate.” Despite bipartisan support, the bills never got out of committee. They should be re-introduced.