Coroner and Medical Examiner Testing FAQ

 

What services are provided to the Coroners and M.E.’s?

The Forensic Toxicology section provides laboratory testing for alcohol and other drugs, carbon monoxide, and some toxic metals. The broad-based routine screening procedures detect many prescription drugs, illicit drugs and over-the-counter drugs. Some drugs, notably lithium and some anti-seizure medications, are detected by special procedures when the laboratory has been alerted to their potential appearance in the specimen. Similarly, testing for carbon monoxide and toxic metals requires a specific request for these analyses. A few drugs (inhalants, salicylates, acetaminophen, cyanide, date rape drugs, LSD and hallucinogenic mushrooms) are not detected by WSLH methods.

Other units of the WSLH offer testing for HIV status. Requests to determine HIV status requires an appropriate specimen (serum, rather than the fluoride-preserved whole blood used for toxicology determinations) and documentation in accordance with state law.

The WSLH does not provide DNA analysis or paternity testing. Specimens can be forwarded to outside laboratories for specialized testing upon request. Contact the Forensic Toxicology section at 608-224-6241 for details.

 

What is the cost for the testing?

The majority of coroners testing is currently provided free of charge. Ethanol and drug analysis is provided free for all non-traffic death investigations. Ethanol analysis in Motor Vehicle Deaths (MVD) is provided free for drivers and passengers, as is drug analysis on the driver of the motor vehicle. There is a fee for drug analysis for passengers in a MVD.

 

How long is the turnaround time?

The average time for a negative drug screen is 2-4 months. Results from a qualitative drug analysis are usually reportable in less than 6 months. A comprehensive drug screen with multiple quantitations may take up to 8-9 months. The laboratory is attempting to obtain the resources necessary to improve turnaround time.

 

When will my sample be done?

Please call the laboratory. A chemist will review the specimen status and estimate completion time for you.

 

What is qualitative analysis?

Qualitative analysis can be ordered if confirmation of the presence of drug is sufficient and it is not necessary to quantitate the amount of drug in the specimen. Qualitative screening is often requested where the cause of death seems unrelated to potential drug involvement, as in severe injury, old age, or when death is explained by autopsy findings. Even with a qualitative analysis, some quantitative values may be reported due to the procedures used in the confirmation process. Additionally, laboratory staff may contact you if a large amount of drug is detected and a quantitative procedure seems in order.

 

What should I collect my specimens in?

Whole blood should be collected in the screw-capped tubes provided by the laboratory. These tubes contain sodium fluoride and potassium oxalate, and will hold a sufficient volume of specimen to complete a full drug screen with multiple quantitations. Hospital gray-top tubes are also appropriate. Collect 20 mL (about 3 tubes) if possible. Vitreous samples should be collected in red-top tubes that contain no additives. Urine and gastric specimens can be submitted in any clean, leak-proof container. Please do not send solid tissue specimens, or if solid tissue is the only specimen available, contact the laboratory before shipping.

 

How do I order specimen collection kits?

Collection kits can be ordered from our website, or by calling 608-224-6257.
When ordering please specify if you need blood kits or blood & urine kits. You can also request forms for Motor Vehicle Deaths (MVD) or for general toxicology screening.

 

What information is necessary on the forms?

Please fill out the forms as completely as possible. The Wisconsin Department of Transportation (DOT) uses the yellow MVD form and requires this form be submitted for each motor vehicle death. The DOT may contact you if information is missing or illegible. The WSLH request forms include areas for medical history and prescription information. Having this information helps us to meet your analytical needs.

 

Can you make my specimen a priority?

Generally no, but we will evaluate each case individually.

 

Can you issue a preliminary report with results to date?

No, we only issue final reports when all testing is completed.

 

What does this report mean?

A toxicology report typically lists the drugs detected, the amount of drug in the specimen, and may provide a therapeutic range or comment with each drug. Please note that therapeutic ranges cover the expected ranges for all conditions where a particular drug may be appropriate, and that these ranges are determined in living subjects. Significant changes in drug concentration may occur after death. Each case is unique, and we urge you to contact the laboratory if you have questions about the report.

 

How many pills did he/she take?

This is difficult or impossible to answer based on a laboratory value alone. Confounding factors include the time of use, amount of drug absorbed and individual variations in metabolism. Investigating the source of the drug, through prescription records or medicine containers at the death site, often yields better information.

 

What is a metabolite?

The body converts the parent drug (i.e., the drug in its dosage form) to other forms in the process of eliminating the drug from the body. The converted form of the drug is a metabolite. Some of these metabolites are as active as, or even more active than, the parent compound.

 

Why aren’t the same drugs/metabolites found in the different sample types?

A primary factor in drug/metabolite distribution patterns is the time period between dose and death. If death occurs near in time to the dose, the drug may appear only in the blood. If death occurs many hours or days after the dose, it may appear only in the urine. Other factors may the distribution pattern as well. Please call the laboratory to discuss your concerns.