 Welcome to Sheboygan County Government, working for you. My name's Adam Payne, Sheboygan County Administrator and co-host of this program with Chairman Mike Van der Steen. And as you know, every month we try to bring a different department to you to talk about the programs, the services they provide, a lot going on in Sheboygan County Government. And some of you may not be aware that we have a Sheboygan County Coroner. And today we're very pleased that Mr. Dave Lafine's with us. Welcome, Dave. Thank you. Dave, please begin by sharing a little bit about yourself and when you first became the County Coroner. Sure. Well, I'm a Sheboygan native, born and raised here in Sheboygan, educated in Sheboygan. I became the coroner in 1987. So I'm finishing my 24th year as a Sheboygan County Coroner. I'm married. I have two married children and three grandchildren and one that's on the way and do a Christmas. So since 1987, since 1987, and what are the qualifications to become Coroner? Well, actually, Adam, there are no qualifications. If you wanted to become County Coroner, you could or Mike wanted to become County Coroner. All you need is to in the state of Wisconsin, Sheboygan County, because of our size of our population size of 100,000, you need a minimum of 500 names to get your name on the fall ballot. And if you have named 500 names, your name is on there. And if you get more votes than anybody else, you're the Coroner. However, by profession, I'm a registered nurse. And I certainly can't imagine anyone wanting or accepting or even being fully capable of doing this job without some sort of medical background. Going back in the history of Sheboygan County Coroner system, we've had physicians. We've had pharmacists in the field. A lot of the people that were here before me have long tenure. Dr. Kilderbrand was in for, I believe, 20 years. Dr. Simonson was in around 20 years. I think right now I've had the longest tenure. But that nutshell, that's it. You do not need qualifications that, however, I believe is going to be subject to change in the near future. They're looking at adapting some type of criteria for the Coroner's office. And it's rather remarkable to just hear you say that. I'm sure there were some folks who are watching this who thought, you've got to be kidding me. I mean, the Coroner has very important responsibilities. And you're called 24-7. What are some of the responsibilities that day in, day out that you take care of? Well, the responsibilities of the Coroner essentially are to pronounce death and to determine the cause and the manner of death. Everything in the Coroner's office is based on state statutes. And state statutes indicate that any homicide, any suicide, any death that involves fellow player or suspicious nature are required that the Coroner or the medical examiner investigates that death. So we would pronounce the death. We would certify that it was a natural death or accidental death or homicide. We would fill out the death certificate to the fact of what the cause was. And again, you may win through an election because you're popular or look good or whatever that may be. But when it comes to the serious task of pronouncing someone dead and determining the cause of that death, there must be some training involved, things that you do or your staff do to build up that skill set. Sure, as a state coroner's association, our organization offers training several times a year. My staff and I have all taken advanced training. The acronym ABM guy is American Board of Medical Death Investigators. So we have advanced training into the different facets of death investigation, forensic deaths, photography of the death scene, different things like that. How many employees do you have working for you? I have a total of five deputies besides myself. And you all distribute the workload, take turns going on calls? How does that normally work? Well, it's set up. I take pretty much of the lion's share. I have deputies because the coroner position is not a full-time position. So I have, as we joke about, I have a real job in that being a registered nurse. But we take turns being on call. My deputies will cover during the day while I'm at my regular job, and then I'll cover PMs and nights. I generally take a lot of the weekends and holidays so they can be with their families. But as things are progressing and I'm getting into it into my 24th year, they're kind of taking a little bit more over and doing a little bit more. But the county never goes uncovered. Now, as you mentioned, you're in an elected corner. You've been elected since 1987. And my understanding is you can either have an elected corner or you can have a medical examiner. Correct. What's the difference? How does that work? Difference educational-wise, there is none. The difference comes in, counties with populations of over 500,000 are mandated to have a medical examiner system. That's an appointed system by the county government. They would appoint an individual to be the medical examiner. Counties under 500,000 have the option of either being going with the elected system as we have in Sheboygan or appointing a medical examiner. There are out of the 72 counties, it's probably split 50-50, where in actuality we only have Madison, Dane, and maybe one other county that meets the 500,000 requirement. So they do it as a business sense of the county how they want to prefer to handle that. Any idea what the rationale is for why if you happen to have a population of over 500,000, it has to be an appointed individual versus under. You get the choice? No. I really don't. If you're an appointed, you work at the discretion of the county board. As an elected, I'm at the discretion of the populace, so technically I guess I cannot be fired. I mean, there are circumstances where you could be fired gross misconduct such as that, but that's with any office. Right, right. Very good. And last question, and I'll turn it over to Mike. As you said, you take this different training to determine what caused the death. What type of tools do you use to avail yourself of, I mean, I got to imagine that there can be situations that you can't just look at the person and determine that. You need to do some serious testing and serious investigation. Please share an example or two of how you proceed. You, as a tool that we have, it would be autopsies. And autopsies is used to determine a cause and manner of death, and an autopsy is performed by a pathologist. The coroner's office orders the autopsy, in fact, we maybe even would assist on the autopsy, but a pathologist is the only person can that perform an autopsy. To digress a little bit, in the medical examiner system, a lot of them are pathologists. So they have, they're pathologists, they pronounce the death. They have the option of going into an autopsy at the same day. Very good. Very good. Thank you. Dave, though everybody may not want to have a coroner show up on their doorstep, death is a part of life and it impacts us all. Can you tell us a little bit more about the specifics that you and your staff get involved with? I understand there's like different manners of death that you qualify things as. Right. On the death certificate, death is either a natural death, a homicide, a suicide, accidental, or undetermined. As a coroner, we are mandated or required to investigate all deaths other than natural deaths. So if there's been a murder or a homicide, we have to investigate that by law. Suicides, we have to investigate that by law. Accidental deaths, we have to investigate that by law. The fifth one is an undetermined and that's not used frequently, but there are times when you've exhausted all resources, you've exhausted x-rays, you've exhausted toxicology or lab studies of the blood and other body fluids trying to determine the cause of death, you've exhausted the autopsy aspect and sometimes someone dies and you just can't say why. There are probably the most common form would be someone would have an arrhythmia, an interruption in the heart rate. You can't see an arrhythmia, you can see a myocardial infarction where you have actual damage to the heart, but you cannot see an arrhythmia, an arrhythmia is an interruption. So it breaks up the heart rate. Just like a simple example would be you turn a light switch on, you turn the light switch off and at some point in time that light may not go, the bulb burns out, that's an interruption. Same thing can happen to the heart and you can't always tell even after you've exhausted all your studies. How many deaths do we usually have in Sheboygan County in a year? We probably have close to 2,000 deaths in Sheboygan County, however my office investigates probably around 500 of them, so about one fourth. In what instances are you required to conduct an investigation to determine the death? As I said earlier, anything that's other than a natural death. So if there's a suspicious death that you don't know what it is, you look into it, you do tax ecology studies, you're suspect of things such as a suicide, you maybe think or feel or everything points to a suicide, you may even have written notes but you do tax ecology studies, so that's one way you go into it. A traffic accident where you want to determine whether the accident caused the death or the person died of natural causes and that led to the accident. Dave, you had mentioned just before we started taping this program that a real simplistic way to determine whether or not it's a death that you follow up on or investigate, whether it's in an institution or out of an institution, I think that's a real nice way of clarifying. Sure. All simple way to do it is all deaths, non-institutional deaths are deaths that a coroner or medical examiner would investigate. Any institutional death, such as a hospital where a person has had a fractured hip, that is reportable to the coroner. Someone has an accident, falls down the steps, hits their head, they die as a result of the head trauma, that is reportable. So there are still institutional deaths that are reported to the coroner and require our investigation. But if it's a hospice or a nursing home or a hospital, that's another issue. Hospice deaths, even though they're under the care of hospice, if they're in the home, non-institutional death, we go. The exception would be in Sheboygan County, we're fortunate enough to have the Sharon S. Richardson Hospice Program. If they die at the Sharon S. Richardson Hospice Facility, we do not go unless they meet the criteria of a fall, of a fracture, a head trauma, but there are still times when we go there also. Nursing home deaths, if they haven't been seen by their primary physician in the last 30 days, we go to those. If there's any injury or choking episodes, sometimes you're elderly. In their frailty, they may choke on the food, so you may have a situation where you have a choking death. Dave, people in Sheboygan may not be aware of the fact that we have a county morgue. You tell us where that's located and how often the morgue is used. Sure. The Sheboygan County morgue is located in the lower level of the courthouse. And as far as usage, I've always been a conservative corner. We only do autopsies when we absolutely have to. What I love to do in autopsies on every death, oh absolutely, there's nothing better than to find out the root cause because this is an educated guess in some instances. You take the doctor, you take the medical notes, you take, look at the medication, you look at what was going on in their life before they passed, but you would still like to do an autopsy on a lot of them, but that would be cost prohibitive. If you look at 200 deaths in Sheboygan County or even the 500 we see and the cost of the autopsy, Adam would not be real happy with me and my budget. So we're conservative. We don't ignore them, but we do them when they're absolutely necessary. Now I understand that Sheboygan recently invested some money in remodeling and modernizing the morgue. Could you tell us a little bit about what that's entailed and why that was important to you and your department? Sure. The morgue was put in when the county courthouse was built and I believe that was in the 30s. At that time they had the office space for the coroner, they had the actual, the morgue, they had what we call a tray refrigeration unit. The facilities were quite old, needed updating, the ventilation system was poor and we upgraded, we put in a walk-in, what we call a walk-in cooler where when the body is brought into the morgue placed on a cart, it stays on that cart until the funeral makes the removal. So we do the autopsy right on that cart. We have a ventilating system, state of the art ventilating system that exchanges the air in the morgue numerous times per hour. I don't know the exact amount of times it changes, but a state of the art. We now have office space back for the coroner. We have record storage area now. And another use for the morgue, I'll digress into that Adam, is tissue procurement or tissue harvesting, not to be confused with organ donation. Organ donation is when someone was involved in an accident or an injury or was in a hospital where they're maintained on life supports and it's determined that they have reached brain death and they will not recover. They are a candidate for organ donation, heart, liver, kidneys, thing is you have to maintain perfusion of these bodily organs through artificial support. Tissue harvesting or tissue donation can be done on a deceased person up to a certain time frame after death if the conditions or environment is right and refrigeration is one of those requirements and a time frame of less than 18 hours or 12 hours in most cases. We have now have the facilities where we can do that where the harvest team comes in from Milwaukee or Madison. We have a changing area for them. We have locker area for them that their clothing is secured or their personal items are secured before they had to leave the morgue, go into a public restroom, change clothing. It worked but it was certainly not a good situation. Tissue donation is a gift that people can give. You can use, take skin, take bone, you can take connective tissue, there's different things they can do. Human for burn victims, cancer victims, bone for individuals with bone cancer, connective tissue for joints, heart valves they can take, different body parts that they can use. Everything when the tissue procurement people come in everything is done in a sterile manner although the morgue is not as an operating room is a certain sterile or cleanliness closest thing they can get to it. They have everything they do is under sterile technique, gowns, mask, sterile sheets, sterile towels, gloves. The body is treated with utmost respect and it's a wonderful, wonderful gift. Tissue donation can provide gifts for 30 to 40 other individuals. Well it's good to know that you've got a facility that you can use in that manner. With that I'll turn it back over to Adam. One of your deputies who took the lead on your behalf with the morgue and his name is... That would be Bob Culhanick, my chief deputy coroner. I really think he deserves a shout out because he did a nice job on your behalf and on behalf of your staff to make the case to the county board and of course Chairman Van Der Steen was very supportive and I'll never forget when he came to the finance committee. Can you say his full name again? Robert Culhanick. Culhanick. When he came in he had photos and if you could imagine an outdated morgue from as you said the 30s with a tray situation where he described you know people and I'm one of them. We're a little bigger and heavier than we may have been in the 30s and 40s and he described situations where you literally had to crawl into the cooler and sometimes over the body to remove it because the cooler and the sliding mechanism just wasn't built for today's use. Right. I just thought he did a terrific job making the case and I'm just proud of the fact that the board supported it during tough economic times and we now have a morgue that is more conducive to the needs of this community and provides you with a better working environment so I thank you for your leadership on that and again Chairman Van Der Steen and the county board deserve credit for that as well. Absolutely. Moving right along once you go through this process and I hope folks are appreciating that Dave is one of the most interesting departments I have to work with. These are unique conversations that most of us don't get to have every day and of course Dave knows the stuff inside and out and is highly qualified to do what he does. Once you've gone into the scene and dealt with the situation as respectfully as you can and with the loved ones that may or may not be there and perhaps you've done it on an autopsy perhaps not but what happens after you've made your determination of cause of death? Could you walk us through the next steps? It all depends on the situation where it's at Adam if it's a home death after we've been there can't you had a chance to talk with the family explain what we've found what our thought process is what our anticipated result is going to be as far as the cause doesn't matter when the family is ready we give the funeral home a call. Funeral home will come take the the deceased to the funeral home they will set up time with the family the next day and go through that process with them. If it's a traffic example a traffic scene where we maybe don't have necks of kin right off right away we'll we'll make a removal of that body and we'll take that body to the county morgue until we can notify necks of kin nursing homes or hospitals families most often there or they're notified and the same thing when when we've talked to them and everything is said and done the funeral home again is called and there again your work still isn't done then the body needs to be cremated or buried what are the the four forms of sure it's called the disposition disposition you know a common common disposition is earth burial or entombment at one of the mausoleums third one would be cremation and the fourth is scientific donation. Scientific donation is when someone donates their body to science for either Alzheimer's study of the brain or this general study for med students to have the opportunity to to look at a body do an autopsy of the body find out different things about the organs invaluable gift there also and when when the the medical institutions are done with the body the body is cremated and the ashes are returned to the the family but not all corner cases or I should see not all deaths or burials there are some that are cremations not all cremations are necessarily corner cases so if it doesn't happen to be a corner case in the beginning it becomes an investigation because once the body is cremated there is no going back and and exhuming the body for further studies or investigation or taking the body out of the mausoleum so we investigate the cause and manner of the death of what physician X has put down on that death certificate we make sure that the body has no trauma that is not consistent you know with the situation prior to death so we investigate that also and what's the general trend out there are you seeing more people choosing to cremate loved ones or is there a well we out of those just probably out of the two roughly two thousand fifteen hundred to two thousand deaths in Sheboygan County we have about 450 cremations so that leaves probably two-thirds that are either burial or entombment only have a couple of minutes remaining and as you said since 1987 tremendous run of public service to this community of a position as Mike mentioned earlier that not everyone is necessarily looking for you to walk to their doorstep but when they have a loved one that needs you there I'm sure they're they're pleased to have you there what have you found most rewarding about the job why did you run for it to begin with it was my sense of community service not necessarily feel for it not everybody can do it as you said I've been very fortunate that my staff is very professional in how they handle things we can go to a home and we do our job with the utmost care and consideration we've left with families we've cried with families probably the most rewarding every once in a while maybe four or five times you you're gonna thank you know what I mean I just very touching hardest thing little children just to hold that child and tell their parents I'm sorry right and as we speak or tape this program there's a young girl perhaps out in Lake Michigan that's a situation where you would be called absolutely right right well thank you Dave for your 23 years of service with Sheboygan County is County Corner and the staff that you have and the and the important work that you do we certainly appreciate it thank you if you have questions don't hesitate to contact your County Corner Dave Lafine I'm sure he'll be happy to talk to you and and if you've dealt with Mr. Lafine in the past send a thank-you note as you can tell he takes his work very seriously and it's very important work next month we're going to have another department head here also takes his job very seriously in that Sheriff Mike Helpeke law enforcement the Coroner's Office certainly have to coordinate from time to time and Sheriff Helpeke has done a very good job during his tenure as Sheriff and we look forward to hearing from him and hearing more about the challenges that law enforcement has so until then on behalf of Chairman Mike Vanderstien and the County Board thanks for joining us