I found your blog through the PsychCentral awards last week...maybe that's a source of the traffic?

On the subject of suicide data, the Portland Oregonian has an article today about Oregon's high suicide rate (see link at end of this comment), and I question this data based on my experience with the medical examiner's office following my son's death last year.

My son shot himself when he was barely 16 and became paralyzed from the chest down. He had a serious learning disability and was diagnosed (after his injury) with major depression. He lived for 11 years after his injury, in relatively good health but with chronic pain. He was on two antidepressants for the last six years of his life, and worked hard in ongoing therapy to learn to deal with his emotions and his painful and confining life situation. In 2003, a medical device to treat chronic pain was implanted in his lower back (an intrathecal pump). The pump contained morphine and clonidine.

In 2005, a huge error was made when the admixture for the intrathecal pump was compounded. The error was missed by the doctor and the home health nurse who filled the pump. The mistake in the solution was from 20 micrograms of clonidine (per ML of solution) to 20 milligrams (per ML of solution), a thousand fold error. My son became gravely ill, began hallucinating, and was hospitalized for a month while doctors tried to figure out what was wrong, and then, once they knew, to titrate the medication slowly because it can cause hyper- and hypotension if titrated too rapidly.

My son never recovered, and died 8 months after the titration was complete. The autopsy showed that he died of respiratory failure, that his heart was enlarged, he had pulmonary edema. (My son's heart and lungs had been CT scanned at the time of the overdose, and had been normal then). My son was seeing a psychiatrist for ongoing hallucinations for the last four months of his life, and the psychiatrist says that he was experiencing "clonidine flashbacks", PTSD from the overdose, and psychosis NOS because he sometimes believed the bugs were real.

The medical records were clear that the overdose had occurred, and the Pharmacy Board later took action against the pharmacy. However, the medical examiner dismissed those facts as irrelevant. He told me before he received the toxicology reports that if he couldn't find anything else, he would rule my son's death a suicide. I was shocked and argued with him, but he insisted (and still insists) that my son's death was a direct result of the self-inflicted gunshot wound 11 years before his death. The medical examiner did not mention the catastrophic medical error in the autopsy report or the death certificate because "it wouldn't have happened if your son hadn't shot himself."

Later, when the toxicology reports came in, the ME told me that my son had died from a fentanyl overdose (he had been taking Actiq for breakthrough pain). The ME said his blood levels were "off the charts." I was shocked and told him it didn't fit with the known facts, and he agreed to change the cause of death to "fentanyl toxicity" rather than "fentanyl overdose." He left the "manner of death" blank, though he said he would have concluded that my son's death was a suicide if there was any evidence that my son had intentionally shot himself 11 years earlier. ("Evidence" would have been powder burns and/or a wound that was obviously self-inflicted, like a gunshot wound in the head).

When I finally felt strong enough to do some research months later, I discovered that the levels of fentanyl in my son's blood were not "off the charts" for opioid-tolerant people. Following that discovery, I called the ME and told him that the levels were not off the charts, and he agreed, but he refused to change the death certificate again. He also refuses to list the massive clonidine overdose as a contributing cause of death because, while he agrees that my son would be alive without the medical error, he says that "if your son had not shot himself, he would be alive today." Post hoc ergo propter hoc.

I told him that I believe he is discriminating against my son on the basis of mental illness and also protecting the medical community. He says that's "absurd."

This story is one of many in which a person with mental illness is blamed for their own death. In this case, the only reason the ME didn't label my son's death a suicide is because he doesn't have proof that my son intended to shoot himself.

Considering the fact that a suicide attempt 11 years before one's death (with no further attempts) can result in a death certificate that says "manner of death, suicide," I question ALL suicide data.

Here's a link to the Oregonian article. http://www.oregonlive.com/news/oregonian/index.ssf?/base/news/1190087711237160.xml&coll=7

Sally G.