Kiessling had told the woman that he would, but the conversation hadn’t happened yet.
Now, Kiessling was handling the man’s death.
Now, it was too late.
“I felt like I got kicked in the gut,” Kiessling told The Washington Post.
The toxicology report on the man’s death wasn’t back yet when Kiessling relayed the story to The Post.
He suspected it would “most likely” be a heroin-related death, though, and it was one that has stuck with him.
“I took that personal,” said Kiessling, who has served as the Lycoming County coroner for more than a decade. “But it also lit the fire under my behind, I guess, to say, ‘You know what? This is nuts. We have to start calling these things as they are.'”
This year, Kiessling’s office started recording the manner-of-death classification in most drug overdose deaths as homicides.
The switch comes amid a nationwide heroin epidemic and was something Kiessling had been thinking about for some time — long before the 27-year-old’s death.
The approach probably doesn’t do any harm, said Randy Hanzlick, chief medical examiner of Fulton County, Ga. But it does go “against the majority opinion of how people are dealing with it these days.”
“To me, that’s more of a legal interpretation or classification than it is a medical one,” Hanzlick told The Post.
Hanzlick is among the authors of the 2002 National Association of Medical Examiners guide, which lays out recommendations for death classifications. Those guidelines indicate that deaths due to drugs have traditionally been classified as accidents, which was mostly what Kiessling was using previously.
“I’ve never heard of it before,” said Jeffrey Jentzen, director of autopsy and forensic services at the University of Michigan, when asked about Kiessling’s decision. “I think it’s very unusual.”
Gregory J. Davis, professor at the University of Kentucky and another author of the National Association of Medical Examiners guidelines, expressed concern over the decision, saying: “This strikes me as more political than scientific, or a real attempt at death investigation. This is at best misguided, at worst, an attempt to get a headline.”
Kiessling’s aggressive stance comes as public health officials are struggling to combat heroin addiction and drug use, both nationwide and locally.
“Heroin — now cheap, plentiful and more potent than ever — is killing people at record rates,” The Washington Post’s Marc Fisher wrote last year. He cited a Centers for Disease Control and Prevention analysis, which found that heroin overdose deaths nationwide had “nearly quadrupled in the decade ending in 2013.”
In 2014, according to the CDC, more than 47,000 drug overdose deaths were recorded in the United States — including 10,574 heroin deaths.
More than 2,480 drug deaths were reported in Pennsylvania during the same year, according to the state’s coroners’ association report.
On Tuesday, President Obama discussed opioid abuse and overdose deaths at the National Rx Drug Abuse & Heroin Summit, saying: “I think the public doesn’t fully appreciate yet the scope of the problem.”
A lot was being done to curb heroin use in Kiessling’s community, he said, but using an accidental death classification felt like he was “sweeping the problem under the carpet, to a certain extent.” Since making the change, Kiessling has so far ruled one heroin-related death a homicide; he has a handful of other cases pending, awaiting toxicology and autopsy reports.
“They’re not accidental deaths,” Kiessling said. “They’re homicides. Drug dealers are murderers. They need to be prosecuted as murderers.”
Homicide is defined as the death of an individual at the hands of another, Kiessling said; when he thought about drug deaths, the victims were dying at the hands of a dealer or supplier.
“You’re killing people if you’re selling drugs,” he said.
But these types of issues aren’t always so black-and-white, said Davis, the Kentucky professor.
What about cases that involve alcohol-related deaths, for example? And is this the job of a county coroner, anyway — to make a statement about drug use and the heroin epidemic? The classification change is “not going to make these deaths go away,” said Davis, who called the switch “just a facile thing to do.”
“He’s opening a door that I think is going to have ramifications of which he’s not aware at this point,” Davis said. “And, again, I just don’t think it’s his job to make that call as homicide.”
Kiessling, the president of the Pennsylvania State Coroners Association, said he’s not trying to step into the role of law enforcement. And just because a death is classified as a homicide, it does not necessarily mean criminal charges will follow.
In Pennsylvania, dealers can be charged with drug delivery resulting in death, said Richard Long, executive director of the Pennsylvania District Attorneys Association. But the manner-of-death classification doesn’t mean law enforcement necessarily has to take a supplier to court.
“From a law enforcement perspective, and our ability to continue to prosecute drug delivery resulting in death cases, it’s not going to have a significant impact,” Lycoming County District Attorney Eric Linhardt said. “It doesn’t change the relationship that my office and law enforcement has with the coroner’s office, and it’s not going to impact our decision-making process in whether or not, ultimately, we’re able to prosecute these cases.”
Prosecuting the cases isn’t an easy task, said Linhardt, who told Penn Live that it was important for the public to realize that a coroner’s homicide ruling on OD deaths is “not a legal finding of homicide.”
Often, there’s a mix of drugs in a person’s system, which makes it hard for a pathologist to give an expert opinion on the death. Plus, law enforcement has to identify the dealer — and prove that he or she supplied the drug to a user.
“Drug delivery resulting in death cases are difficult cases to prove and prosecute,” Linhardt said. “And I know that coroner Kiessling appreciates that. And we’ll continue to work closely with our coroner, and where the facts and evidence allow, we’ll prosecute these cases where we’re able.”
When asked if he felt like he was making a statement with the classification change, Kiessling said: “I guess I am.”
“I think I have 35-plus years of nursing and working the coroner’s office, and I think I can render an opinion, you know. If people don’t like it, I can’t help that,” he said. “But the facts are very real. And the bodies that we’re seeing related to this stuff are very real.”