The coroner in Morgan County, Ill., notified nursing home investigators last year when he determined that a nursing home resident had died after choking on a piece of ham.
Coroner Jeff Lair, who asks that nursing homes in his county report all deaths to him, said investigators then cited the facility because the resident was supposed to be on a special diet and be supervised while eating but was not.
The coroner in Effingham County, Ill., also contacts state officials about nursing home deaths.
"We have to speak for these people," said Leigh Hammer, Effingham's coroner. "We have to give them a voice. Just because they are elderly doesn't mean that they were meant to die."
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Kentucky does not require nursing homes to report most deaths to coroners, who are rarely called even when abuse or neglect are suspected. However, that might change if a bill proposed by Rep. Tom Burch, D-Louisville, passes.
Burch is meeting Wednesday with state officials and nursing home representatives to discuss a law that would require the facilities to notify coroners about all deaths.
The state medical examiner's office is working with Burch to see that "suspicious deaths and elder abuse are investigated to the fullest extent possible," said Jennifer Brislin, a spokeswoman for the office.
The Kentucky bill requires a specific staff member at long-term care facilities and hospices to report all deaths to the county coroner within 24 hours. It also requires coroners to involve police or prosecutors if they suspect abuse or neglect.
The bill is intended to give coroners discretion in choosing which deaths need to be reviewed by other officials, Burch said.
Gov. Steve Beshear's administration conducted an internal review last year of how nursing home abuse and neglect allegations are investigated. Previously, Herald-Leader articles looked at gaps in the system used to investigate nursing home abuse.
Coroners and medical examiners in other states said it has been beneficial to have coroners investigate nursing home deaths.
Missouri and Arkansas have laws that specifically require nursing homes to report all deaths. Some coroners and medical examiners in Texas and Illinois also ask the facilities to report all deaths, even though their laws don't require it.
In some states that require such reporting to the coroner, nursing home officials also fill out and fax a form about the death. The coroner decides whether to investigate further or to refer the case to other agencies.
In Little Rock, Ark., a member of the coroner's staff goes to the nursing home, examines the body and interviews staff members and the resident's family, said Garland Camper, coroner for Pulaski County, Ark.
Camper said he refers 30 to 35 cases a year to a forensic examiner and also sends cases to state investigators.
Nursing home residents are getting better care because of the law, Camper said.
"They know our office is going to come," he said. "We're going to follow up with the level of care that individual was supposed to be receiving inside that facility."
William Rohr, the medical examiner in Collin County, Texas, near Dallas, said investigating nursing home deaths "is how the public would expect a medical examiner's office to operate."
Rohr said his office goes even further.
"We have regular surveillance of death certificates in the county clerk's office every month to make sure the nursing home deaths are reported to us," he said.
Tom VanDeBerg, deputy medical examiner in Greene County, Mo., said he reviews 30 to 40 cases a week in Springfield and finds three or four cases each year suspicious enough to contact state nursing home inspectors.
Before the law, said VanDeBerg, "there were a lot of cases that should have been reviewed and were not."
Meanwhile, Beshear is reviewing Burch's bill, spokeswoman Kerri Richardson said. "We ... will continue to consider ways to enhance our protection of seniors while weighing our budgetary constraints," Beshear said in a statement.
House Speaker Greg Stumbo, D-Prestonsburg, said: "We'll take a close look at this legislation. ...We need to do all we can to help those who are the most vulnerable in society."