Since the arrival of the COVID-19 pandemic to Pennsylvania last spring, 527 people in Lancaster County have died as a result of the virus, according to the state Department of Health.
But that number doesn’t match the total complied by county Coroner Stephen Diamantoni. His office counts just 508 COVID-19 deaths.
The discrepancy is the result in the different ways that coroners and medical examiners (i.e. elected or appointed officials who investigate deaths in each of the state’s 67 counties) and the state’s top public health agency record deaths. State officials associate a death with a person’s county of residence, meaning the death of a Philadelphia resident in Lancaster would be added to Philadelphia’s death toll.
“It is important to count deaths in this way [residency], because we know in many areas, someone may have to go to a larger city for medical treatment,” Health Department spokesperson Nate Wardle said in an email. “For example, if someone had a heart attack in Lebanon County, and was taken to Lancaster General for treatment, they would still be identified as a Lebanon County death.”
Diamantoni, however, would count that hypothetical death as occurring in Lancaster County.
Counting and attributing deaths is just one area where the state and county coroners differ, the most important being the requirement that health facilities report deaths to the state, with no corresponding requirement that the information be reported to the local coroner.
The result leaves coroners having to maintain contacts with multiple health facilities in their county as a way to get frontline providers and institutions to voluntarily share the information.
Diamantoni said he has had no issues collecting data from facilities in Lancaster. For coroners in other parts of the state, it hasn’t been as smooth.
“We’re still catching some of these deaths that are falling through the cracks...we’ve recently picked up on a few that weren’t reported,” Charles Kiessling, Lycoming County coroner and state Coroner Association president, said. “The ones that die in nursing homes or hospitals may or may not be reported to us.”
In the eyes of the health department, Pennsylvania’s vital statistics law only requires that coroners be notified if a death is not attended by a medical professional, or the circumstances of the death are sudden. Coroners, however, insist that county codes require them to investigate, or be made aware of, deaths caused by communicable diseases.
According to county coroners like Lackawanna’s Tim Rowland, the lack of a reporting mandate hinders his office’s ability to protect the community, especially emergency responders.
“If I knew today that a patient tested positive that was brought into the hospital, I have access through 9-1-1 to which ambulance took them to the hospital and I'm able to contact them and say, ‘You’re not aware this person died and they died because of COVID,’” Rowland said.
A legislative fix pushed by state Sen. Judy Ward, R-Blair would have required that all COVID-19 suspected deaths in a county be reported to coroners for an investigation. The bill was passed by the legislature in October but was vetoed by Gov. Tom Wolf on Nov. 3.
In his veto message, Wolf said that an additional reporting requirement would cause delays in reporting from facilities to the state Health Department and that it could result in the release of “highly sensitive personal information” without the protections guaranteed by the state’s Vital Statics Law, which the department follows.
For Lackawanna County’s Rowland, Ward’s bill would have ensured that all nursing home facilities in his county report their COVID-19 related deaths to his office. But beyond getting access to data, Rowland said the lack of access to information on who has tested positive for COVID-19 leaves him unable to warn emergency responders who may have been in contact with the deceased individual.
Rowland applauded DOH and Wolf for their overall response to the pandemic with their restrictions to stop the spread. However, when it comes to reporting deaths, “they have no clue,” he said, referring to an April communication to health providers that some coroners interpreted as an instruction not to report COVID-19 deaths to the local coroner or medical examiner.
“DOH dropped the ball, told people not to follow the law,” Rowland said. “We’re at their mercy getting data.”