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Articles / 2007

Investigations: County follows state regulations, autopsy protocol in such cases

Ventura County Star
Sunday, 11/07/2007
By Michelle L. Klampe

Roughly three-quarters of the sudden, unexplained infant deaths in Ventura County from 2000 to 2004 were attributed to Sudden Infant Death Syndrome, according to a Scripps review of data from the Centers for Disease Control and Prevention.

SIDS deaths don't occur often here. The Ventura County Medical Examiner-Coroner's Office has recorded just three SIDS deaths this year, and fewer than 10 each year for the past 10 years. There were six in 2006; seven each in 2005 and 2004; and three in 2003.

When an infant dies suddenly and unexpectedly, state law and an autopsy protocol that runs more than a dozen pages help determine what might have caused the death, said Dr. Ron O'Halloran, the county's chief medical examiner-coroner.

California Government Code section 27491.41 (e) provides the framework for the investigation and ruling on cause of death when it comes to SIDS, O'Halloran said. It reads, "The coroner shall state on the certificate of death that Sudden Infant Death Syndrome was the cause of death when the coroner's findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol."

Sometimes, the infant is pronounced dead at the scene, and coroner's investigators begin their work there. More than half the time, though, the infant is rushed to a local emergency room.

Dr. John van Houten, a neonatologist at Community Memorial Hospital, has gotten called to the emergency room several times in his career for suspected SIDS cases. The parents' stories have a familiar ring: They put the child down to sleep then came back a few minutes or a couple of hours later to find the baby not breathing and unresponsive. There isn't much van Houten can do.

"The babies are always well-dead before they get to the emergency room," van Houten said, leaving parents grief-stricken and filled with questions.

"There are lots of cases where everything is done correctly, and you still have a SIDS case," he said. "It's just so indiscriminate. Why this baby? That's the frustrating thing about SIDS."

The county's deputy medical examiners usually start their work by interviewing family members, visiting the scene where the child died and reviewing medical history. Each child also undergoes a thorough postmortem examination, including autopsy and toxicology tests. O'Halloran and his staff look for signs a child might have suffocated or been smothered, suffered pneumonia, or had a genetic or metabolic disorder.

The biggest challenge for investigators is to gather information without accusing parents or making them feel guilty for their child's death, O'Halloran said.

"In most cases, nothing looks suspicious," O'Halloran said. "It's a human issue. Do you lay a heavy guilt trip on folks and treat them as suspects, or do you treat them with compassion?"

They also look at whether factors such as an infant sleeping in the parents' bed, or hyperthermia, in which the child gets overheated, were present. Even when they are, SIDS may still be listed as the cause of death, O'Halloran said, because the evidence doesn't support another cause.

"SIDS is a syndrome. It encompasses the ambiguity," he said. Listing deaths as "undetermined" because a factor like cosleeping is present doesn't help researchers understand SIDS any better. "Those not using SIDS (as a cause of death) are making it harder."

When a hospital or deputy medical examiner begins working on a suspected case of SIDS, Ventura County public health nurse Diane Bock also gets a call. Bock is the nurse assigned to provide support for families of SIDS victims, helping to answer questions.

Having such a nurse available to families or caregivers is part of the state's protocols for public health agencies, said Susan Loring, program coordinator for the county Health Department's Community Health Nursing programs. The county has provided the service for nearly 20 years.

"We're not investigators. Our role is supporting the family in the grief and bereavement process," Loring said.

Once SIDS is confirmed as the cause of death, Bock contacts the family and offers to stop by with information or to answer questions. Even if family members aren't ready for a visit, she'll offer to drop off literature for when they are ready. If Bock is meeting with parents, another nurse will visit the baby sitter or caregiver, if there was one, to avoid any conflict of interest.

"I offer it to whoever is interested," Bock said. "Sometimes it's the grandparents or the day-care provider, especially if the baby died there."

The visits provide family members an opportunity to share memories, ask questions, or get referrals to services such as support groups. That might occur in one visit or a series, or it might just happen over the phone, Bock said, depending on the family's needs. Parents often want to know if their child suffered, if there's anything they could have done to prevent the death, and whether any future children might be at risk for SIDS.

"They always say, What caused it?'" Bock said. "We don't have a cause. We try to reassure them there really is nothing they could do."