Local coroner has new method at his disposal
LEWISTOWN — Testing for local, suspected drug-related deaths no longer costs Mifflin County taxpayers thousands of dollars. Dan Lynch, coroner, has cut costs from $3,000 for the average autopsy to $300 per forensic test, using a Quantisal Oral Fluid Collection Device — a qualitative test offering through SteelFusion Clinical Toxicology Laboratory, in Monessen.
“It’s not the standard practice to do autopsies on drug cases,” Lynch said.
Lynch has used this method for toxicology testing since 2017. Within the past month, one case to which Lynch responded appeared to be from natural causes; however, the oral swab results showed the deceased had overdosed to commit suicide.
Chief Deputy Coroner Alan Sunderland fully supports using this alternative testing method to keep up with the times.
“We have to move forward with the new technology that is available, or we stay behind,” Sunderland said.
Lynch said a coroner’s job is to determine the cause and manner of death, which he said is better accomplished with this new testing procedure, especially on suspected drug-related deaths. If such a report comes in, the body is first tested using a urine dip. Autumn Miller, technical supervisor at SteelFusion, said the dip determines the class of drug in the body’s system.
“Urine dip cups usually screen anywhere from five to 14 drug classes,” Miller said. “For example, the opioids drug class may be positive in the urine screen, but until the results are confirmed with a quantitative analysis, it is not known which opioid drugs are present, nor the concentration.”
Following the dip, Lynch said an oral swab is conducted and sent to SteelFusion, where a quantified lab report is conducted within 48 hours. SteelFusion’s Oral Detector kit includes the collection device, the transport bag, evidence tape, an analytical request/chain of custody form, a shipping bag and a return label, according to Miller.
A completed report from SteelFusion includes the sample ID, the decedent’s name and date of birth, the coroner who submitted the sample for testing, the date and time the sample was collected, the name of both oral fluid tests ordered, the analytes detected, the concentration and the laboratories established cut-off levels, according to Miller.
Though some in the local medical community believe this method to be “junk science,” Lynch said the accreditations received by SteelFusion say otherwise. According to data documented on various lab websites, SteelFusion is accredited by seven out of eight organizations versus six that accredited National Medical Services labs, three that accredited Axis Forensic Toxicology and two that accredited PinPoint Testing.
Lynch said his interest in this alternative forensic testing stemmed from a control study, in which he and other coroners throughout the state participated.
“Coroners and medical examiners participated in collecting oral fluid and other available matrices from 25 male and nine female cadavers,” Miller said. “Oral fluid was collected with the Quantisal Oral Fluid Collection Device. The present study indicated that utilizing oral fluid in postmortem toxicology was practical compared to conventional biological samples, particularly in decaying cadavers, where the number of viable samples is limited.”
Miller said that out of 34 cadavers studied, 32 — including two that had decomposed and two drowned subjects — had detectable and quantifiable drugs in the oral fluid and/or blood, urine, bile, vitreous fluid and/or liver tissue.
“Our assessment of oral fluid suitability was based on whether the given analytes could be identified and quantified in postmortem subjects,” Miller said. “We found that the quantification of drugs in oral fluids was generally comparable to quantifications in traditional biological matrices. Moreover, we demonstrated that oral fluids could easily be collected from cadavers, and that samples were stable over time. These findings indicated that oral fluid represents a viable alternative to traditional matrices for the detection and quantification of drugs in postmortem subjects.”
According to Miller, the study began in March 2015, continues to this day and has included Mifflin, Elk, Montour, Lycoming, Columbia, Huntingdon, Franklin, Dauphin, Westmoreland, Fayette and Lycoming counties.
After participating in the control study, Lynch’s interest grew from witnessing the speed of the results as well as realizing the cost efficiency.
“It’s imperative of me to watch tax dollars,” Lynch said.