Colorado’s health department changed the way it publicly reports coronavirus deaths Friday, introducing a second category of fatalities after its methods came under scrutiny — including by a state representative who’s calling for the agency’s chief to be investigated.
How COVID-19 deaths are counted has become politically divisive, with critics claiming the numbers are inflated and medical experts saying deaths may actually be undercounted. Still, the number of deaths is a crucial data point that informs public understanding of the pandemic’s severity and health officials’ response to the crisis.
The Colorado Department of Public Health and Environment is now clarifying that its death tally includes the total number of fatalities among people who had COVID-19, including those deaths in which the respiratory disease was not the cause of death listed on the death certificate.
By the agency’s count, there were 1,150 people who had died with COVID-19 in their systems as of Thursday.
Unlike that total, which has been updated daily by the agency since the start of the outbreak, death certificate data only shows 878 deaths were caused by the new coronavirus between Feb. 1 and May 9 — but that number is expected to increase as there is a several-week lag.
“It’s what we know today as the number of deaths due to COVID based on death certificates,” said Chief Medical Officer Dr. Eric France, adding, “Either way the numbers are too high and there’s more to be done. We should be focusing as much as ever on what we can do to control the spread.”
Rep. Mark Baisley this week alleged the Department of Public Health and Environment has falsified the number of people who have died from COVID-19. The allegation comes amid reports that the health department counted some deaths as having been caused by the new coronavirus despite rulings from physicians and coroners that say otherwise.
“For a state agency to come in and start reclassifying causes of death is unusual and kind of disturbs a whole lot of people,” said Baisley, R-Roxborough Park.
Baisley sent a letter dated Thursday to 18th Judicial District Attorney George Brauchler, requesting an investigation “with the intent of bringing criminal charges against” Jill Hunsaker Ryan, the executive director of the state health department. Baisley’s letter was spurred by what he called a “disturbing” discrepancy in reporting at a Douglas County nursing home.
On Friday, Baisley said Brauchler has assigned a senior deputy district attorney to the investigation into potentially altered death certificates.
In a statement released by his office, Brauchler declined to discuss the details of any possible investigation. However, if it is determined that death certificates were altered “it is possible that misdemeanor charges would be filed,” the statement said.
Officials with the Department of Public Health and Environment said Friday they are not altering death certificates, but noted it is difficult to track deaths during such a large public health crisis.
“When COVID-19 is reported as a cause of death on the death certificate, more than likely it will be determined to be the underlying cause of death and contribute to those underlying mortality statistics,” said Kirk Bol, manager of the vital statistics program, during a news conference. “But again, if COVID-19 was not determined to be part of the cause of death it should not be reported on the death certificate.”
How deaths are counted
Public health and medical experts have said counting deaths caused by the outbreak is tricky given a lack of sufficient testing and lags in reporting death certificate data. The accuracy of tests for COVID-19 also has been thrown into question, especially concerning false negatives.
Officials with the Department of Public Health and Environment said they are required by the U.S. Centers for Disease Control and Prevention to track and report the number of deaths among people with COVID-19, including those in which the coronavirus is not listed as a cause of death on their death certificate.
This information, according to the state agency’s website, is important to public health officials as it tells them about the transmission of the new coronavirus and can identify who is at risk of dying from complications from the disease.
Tracking a broader set of data as it relates to COVID-19 and deaths also enables the health agency to compare the epidemic’s toll in Colorado to that in other states that are following the CDC’s directive, public health officials said.
“On one hand we’re identifying and classifying cause of death by COVID,” France said. “And the other hand, we’re doing the important public health work by identifying cases, who also have died while they had COVID, either from it, or from something else, which is important as we do apples to apples comparisons across the state.”
But there have been questions about the accuracy of how the health department is tracking deaths where the disease is not the direct or partial cause of death.
Montezuma County Coroner George Deavers said he had a case, first reported by 9News, in which a man died with COVID-19 but had a blood-alcohol level of 550 mg, well above the lethal amount. As a result, Deavers ruled the death was from alcohol poisoning. But, he said, the Department of Public Health and Environment counted it among its broader number of 1,150 COVID-19 deaths.
“I feel the state was wrong,” he said, adding, “If it’s a COVID death, it needs to be reported as a COVID death. If it’s not a COVID death, it doesn’t need to be reported as a COVID death. I’m not trying to pad the deaths one way or another.”
COVID-19 is considered the cause of death when a person dies from a complication from the disease, such as pneumonia or respiratory failure, and would not have died at that time or place without the coronavirus. This includes people with underlying illnesses, such as lung and heart diseases.
But making these decisions on the cause of death can be complex. In La Plata County, Coroner Jann Smith had a case involving a person who had a long history of heart issues and while at the hospital tested positive for COVID-19.
Once the patient went home under hospice care, he tested negative. So when the individual died, Smith determined the heart issues were the cause of death.
“If he would have come back positive again, I might have done something different,” she said, adding, “I won’t say it was an easy decision. That was my decision and I’m comfortable with it.”
Still, the health department included the death in its tally of COVID-19 fatalities.
“They have their guidelines to go by, and I have my decisions,” Smith said. “I respect them for theirs.”
The case of Someren Glen
Baisley’s call for an investigation into the state health director was inspired by an April 17 letter written by Tim Rogers, executive director of the Someren Glen retirement community. The letter, which went to residents and their families, said the Centennial facility was aware of four residents whose deaths were confirmed to be related to COVID-19.
Someren Glen’s attending physician, Rogers wrote, determined other recent deaths, including at least one of a resident who tested positive for the virus, were not caused by the coronavirus.
However, he said, the Department of Public Health and Environment counted at least seven resident deaths from the coronavirus — three more than his staff had calculated — and was deciding whether to include a potential eighth death that a physician had ruled was not COVID-related.
“(W)e were informed of their intention to override some of our attendant physician’s rulings and reclassify some resident passings we have experienced in the past few weeks,” Rogers wrote, adding, “We have never seen a situation where the health department overrules a physician’s findings. However, these are unprecedented times and the health department official did not share their motivation for changing physician’s orders.”
Pam Sullivan, spokeswoman for Someren Glen, said the purpose of the letter was to be “transparent.”
“The intention of our letter was to inform residents, families and team members that there would be a change in the numbers we were reporting of residents who had passed directly related to the COVID-19 virus due to re-classifications made by the Colorado Department of Public Health and Environment,” she said in a statement. “We have no involvement in the classification or re-classification of a resident who passes at our communities.”
France, the state’s chief medical officer, said he didn’t have details of the Someren Glen deaths. Cause-of-death determinations on death certificates are medical opinions by the coroner or a medical examiner or physician “and there isn’t a process by which we review and change them at the Department of Public Health,” he said
But Baisley characterized what happened as “government imposition, overreach, in a very intimate way.”
“You don’t mess with people’s families like that,” Baisley said. “Boy, for a state to come in and say, ‘We’re going to change (a cause of death) to COVID-19,’ because of whatever their motivations are, why would you do that?”