Lifesaving or misguided? Funding Pa. coroners with opioid settlements criticized

HARRISBURG — A lot of people hope opioid settlement money will save lives.

Democratic Gov. Josh Shapiro, who negotiated settlements with opioid companies as Pennsylvania's attorney general, said in 2021 that the funds would “be earmarked to offer and expand life-saving treatment options.”

The National Association of Counties has described saving lives as a goal for local leaders across the country.

When a large coalition of professional and advocacy organizations, coordinated by faculty at Johns Hopkins Bloomberg School of Public Health, released principles to guide opioid settlement spending, they listed saving lives as the first one.

But officials in at least three Pennsylvania counties decided to spend part of their share of the state’s billion-dollar windfall to support an office that is primarily responsible for responding to and investigating deaths: the county coroner.

Chester, Lawrence, and Lehigh Counties reported spending or committing a combined $195,600 in settlement money to support the work of their coroners’ offices, as of the end of last year.

Some advocates for people and families dealing with addiction have questioned whether the use aligns with the terms of the opioid settlements — or whether it’s a good idea.

“We should be looking for ways to keep people alive rather than looking for ways to handle the burden of deaths,” said Kathy Strain, a Berks County resident who works on mental health and substance use disorder issues. She has had more than one family member die from an opioid overdose.

Whether a state oversight board — which has done much of its work in secret — will ultimately allow counties to use the funds for this reason remains to be seen. State Sen. Greg Rothman (R., Cumberland), who serves on the board overseeing the funds, has expressed support for allowing coroners to use settlement money.

“There’s a lot of stress that’s been put on government agencies and our counties because of the opioid crisis that this fund is supposed to help relieve,” Rothman told Spotlight PA. “And this seems to me to be a common sense way to relieve some of that stress.”

The issue has opened up a debate over what types of responses to the opioid epidemic truly save lives, and whether data from these offices will ultimately lead to more of a focus on prosecuting people who use drugs.

Advocates question coroner spending

The Pennsylvania Opioid Misuse and Addiction Abatement Trust distributes money to counties, and it has the power to withhold and cut funding if it decides counties spent it inappropriately.

But despite a requirement that the trust follows the state’s Sunshine Act, members first met in secret to review the spending reports from counties and create recommendations for the full board.

At the May 2 public meeting, members of the trust agreed to continue evaluating the Chester and Lehigh County coroner programs. At the same meeting, and without detailing why, the board voted to disapprove of Lawrence County’s coroner program, labeling it noncompliant.

While the trust did not publicly explain the specific questions or objections it had for Lawrence County, some advocates who focus on addiction issues have concerns about using settlement funds on coroners’ offices.

William Stauffer, who advocates for people in recovery, told Spotlight PA the coroner spending plans “seem a stretch at best.”

“I do know from talking with coroners that their budgets have been decimated by the scope of deaths,” said Stauffer, who is the executive director of the Pennsylvania Recovery Organizations Alliance. “They need funding, but these funds should be used to keep people from getting into body bags, not in them.”

Some advocates for people with substance use disorder say they are concerned the opioid settlement money that goes to coroners’ offices could ultimately help prosecutors seek long prison sentences against people accused of providing drugs.

Under Pennsylvania law, people can face up to 40 years in prison if they illegally sell or give drugs to someone who dies as a result of using them. Marianne Sinisi, a Blair County advocate, does not want that criminal charge to be used against people who themselves struggle with addiction.

“How does that help a victim? That’s not going to bring their child back to lock somebody else up that has a disease,” said Sinisi, whose son Shawn died from a drug overdose in 2018.

A Spotlight PA story from 2022 described how the possibility of prosecution influences decisions some coroners make. One coroner said his office ordered autopsies for all overdose deaths in case the district attorney wanted to prosecute the person who distributed the drugs. Another coroner described the potential for charges from the district attorney as a factor when deciding whether to have an autopsy performed.

In late 2022, Luzerne County District Attorney Sam Sanguedolce suggested using settlement money to fund some deputy coroners, citing the role that the local coroner’s office can have in drug delivery resulting in death cases. The county ultimately did not report spending any settlement funds for that reason, as of 2023, according to information released by the county and trust.

The report Chester County submitted to the trust does not mention prosecution when describing the coroner program. But in a statement, the county said its coroner’s office has testified in many trials for drug delivery resulting in death cases and has provided documents in other cases that settled.

At the trust’s public meeting on May 2, Rothman acknowledged concerns regarding coroners’ offices and prosecution but said the information they provide is used for other reasons and would help with treatment.

Chester County officials provided a similar perspective, saying in a statement that information from its coroner’s office can help officials understand the type of treatment a person was receiving prior to their death — which can inform future treatments, and help officials know where to direct education and prevention efforts. Data are “shared with various agencies and task forces to be used to prevent deaths,” the county said.

Some public health experts contacted by Spotlight PA said improving how coroners collect and share data could lead to better public health interventions.

Sara Whaley, a senior practice associate at the Johns Hopkins Bloomberg School of Public Health, said medical examiners and coroners play a critical role in monitoring death trends. But she also urged people making decisions to discuss how the information will be used.

“If there isn’t a specific and coordinated plan of action, then the information isn’t going to trickle down fast enough to save any lives,” Whaley, one of the coordinators of the Johns Hopkins spending principles project, said in an email.

County plans

The coroner spending plans vary among the counties.

In a funding request obtained by Spotlight PA, Lawrence County Coroner Richard Johnson wrote that opioid settlement funds for his office’s budget could “offset the costs of the opioid crisis for many years to come and not place the burden on the taxpayers of Lawrence County.”

The county reported spending $25,000 on that program, one of four programs the trust rejected from Lawrence County. A county official declined to say what changes the county will make now, but indicated it will hold discussions in June to decide next steps.

Chester County was the only other county to have a program deemed noncompliant by the trust in May, according to records released by the trust. In that case, the program aimed to prevent underage drinking.

Chester County partially labeled its coroner program as “Prevent Future Overdoses” and wrote that the money funds expanded toxicology testing. The county spent or committed a total of $140,000 for the program, according to the report.

In a response provided by spokesperson Rebecca Brain, the county said “having the capacity to test for more substances beyond the basic toxicology panel allows for the identification of a much wider range” of drugs, and the county planned to provide further information to the trust indicating how the program aligns with settlement strategies.

Rick Molchany, director of general services for Lehigh County, told Spotlight PA in April that the settlement money provided an “opportunity for us to claw back funding” taxpayers have spent on autopsies and toxicology tests for years.

“This gives a support to the taxpayer,” Molchany said in a later interview. “But at no time does this cover all of the coroner’s office expense.”

The adopted budget for the Lehigh County Coroner’s Office and Forensics Center this year is $3.2 million. Lehigh County had more than 180 drug overdose deaths in 2021 — nearly three times as many as a decade earlier, according to state data.

Lehigh County reported spending $30,600 for the coroner’s office program in its filing to the trust.

The county justified that figure by listing the cost of eight opioid-related autopsies at $2,200 each and the cost of 65 toxicology-only tests for opioid-related deaths at $200 each. Molchany said data from the coroner’s office will help them measure progress, target interventions, and ensure they achieve their goal of reducing deaths.

In order to receive settlement funds from the trust, Pennsylvania counties had to agree to spend the money in ways that are consistent with a document called Exhibit E, which includes a range of approved and recommended strategies. The list does not mention coroners’ offices, but it includes broad language, and it lists data collection of relevant programs as an approved use.

The governor has some influence over the trust, as the order creating the trust says the chair “shall serve at the pleasure” of the governor. The governor also has the power to appoint a secretary of one of the state’s health and human services agencies.

Will Simons, a spokesperson for the governor, said Shapiro “believes this settlement funding should be used for treatment, prevention, and the core strategies that will help the families and communities that have suffered the consequences of this crisis.” But Simons did not directly address questions about funding for coroners’ offices.

In Pennsylvania, state law requires coroners or medical examiners to investigate a range of deaths, including ones caused by drug overdoses. County officials say coroners’ offices have shouldered a heavy burden during the opioid epidemic.

In 2017, Pennsylvania had the third-highest drug overdose death rate in the country. The number of annual drug overdose deaths has more than doubled since 2012, exceeding 5,000 for multiple years, state data show. A 2022 study sponsored by a grant from the Center for Rural Pennsylvania found inequities in how deaths are investigated statewide, due to a lack of standardized training, education, policies, and resources among the offices of the state’s coroners and medical examiners.

Jeremy Reese, president of a statewide association for coroners and medical examiners, said death investigators share data with organizations that work on law enforcement and public health issues.

“Using the data from the deaths does have a downstream impact on preventing future deaths,” said Reese, the coroner in Columbia County.

The decisions the trust makes in the coming weeks regarding allowable spending could create precedent for years to come, which trust Chair Tom VanKirk acknowledged during the May public meeting. He offered an example of a $1,200 program — if the trust approved it, then in the future, a county could come back seeking approval after spending $200,000 on the same program.

“There is no item on this that the working groups felt to be too small,” he said.

Kate Giammarise of WESA contributed to this report.

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