NM researcher: Variation in forms contributes to undercount of police killings

OMI form doesn’t include a field for indicating police involvement

By: - October 6, 2021 7:32 am

Hundreds marched in Albuquerque — and around the globe — every night in the summer of 2020 to object to police killings in N.M. and nationally as part of an anti-racist movement sparked by the death of George Floyd at the hands of Minneapolis police. (Photo by Marisa Demarco / Source NM)

At least one-quarter of the people killed by police in New Mexico over the last four decades do not appear in official statistics, according to a study that made national headlines last week.

Professor Jagdish Khubchandani at New Mexico State University helped with the international research on how police killings are reported. He said one reason for the underreporting is that there’s a lot of variation in the forms coroners fill out. 

Here in N.M., the Office of the Medical Investigator (OMI) looks into any death that is “sudden, violent, untimely, unexpected or where a person is found dead and the cause of death is unknown,” according to its website. OMI is responsible for determining the cause and manner of death in these cases, and the office provides formal death certification.

OMI produces autopsy reports and toxicology reports for the state, then the New Mexico Department of Health collects statistics and hands them over to the National Vital Statistics System, Khubchandani said.

Khubchandani said death certificates in New Mexico are open-ended. If the death certificate is open-ended — and not mandated — medical investigators might not indicate police involvement, he said.

Sometimes it’s also lack of training. What do you fill in? Should I fill in police involvement? Maybe that’s not required. So they just tried to follow instructions and check boxes.

– Jagdish Khubchandani, NMSU professor

Mark Rudi, a spokesperson for the University of New Mexico Health Sciences Center that houses OMI, said death certificates are not issued by OMI but by the Vital Records Bureau of the NM Department of Health. Once OMI completes a death investigation, it forwards its findings to the bureau, which then creates a death certificate based on those findings.

The death certificate wouldn’t get so specific as to indicate police involvement of any kind, said David Morgan, spokesperson for the Department of Health.

UPDATE: Oct. 7 at 11:30 a.m. 

David Morgan responded to questions after this story was first published, and it’s been updated to reflect his comments.

“Even when a death is listed as ‘homicide,’ ‘accident,’ or ‘pending investigation,’ the only thing we can determine from that is that OMI is reviewing the death, and the death certificate will have their involvement,” Morgan said. “Nothing like what you’re asking is included on the death certificate.”

Rudi declined to make anyone at the Office of the Medical Investigator available for an interview about the findings in the study or what kind of challenges OMI faces in labeling causes of death in general.

“The Office of the Medical Investigator did not take part in the study you referenced and therefore we cannot speak about it,” Rudi wrote in an emailed statement. “The OMI is tasked with investigating deaths to serve the living. OMI doesn’t determine if a death was officer-involved. We are alerted if an officer is involved, but OMI is responsible for cause and manner of death.”

An official OMI death investigation summary for a police killing in 2020 reviewed by Source New Mexico confirms that there is no field anywhere in the record that asks the medical investigator to explicitly indicate police involvement in the report.

The death investigation summary does mention, in passive voice, that the person was “reportedly pursued by law enforcement” and “was shot by a firearm,” but does not say who fired the gun. It also notes that “two shots were fired,” but, again, does not say who fired them.

Influence of authority

Khubchandani says it’s not just about the forms. It’s about the people filling them out, too.  

“I think that’s a challenge nationwide, that if you don’t have an appropriately trained person, and someone who can’t be influenced by other authorities, then it becomes a difficult proposition to find out honestly, what’s going on,” Khubchandani said.

New Mexico law requires the state medical investigator to be a licensed physician and “insofar as practicable, the medical investigator shall be trained in the fields of pathology and forensic medicine.” And, by OMI policy, their deputies are supposed to be “specially trained in essential aspects of forensic medicine and death investigation.”

The study also found substantial conflicts of interest within the death investigation system that could dissuade certifiers from indicating police involvement, including the fact that many medical examiners and coroners work for or are embedded within police departments. Sometimes, that’s even one and the same person, like a sheriff who also acts as a coroner.

While OMI is its own independent agency, it is governed by the state’s board of medical investigators, and by law, the head of the Department of Public Safety must have a seat on the board.

The same department in N.M. oversees the State Police, and it’s the primary agency responsible for investigating police killings in the state. Even in cases where state police officers are under investigation, the Department of Public Safety remains the lead investigative agency.

With pressures from above, coroners who face a form that relies on their informed opinions and analyses in some cases, it’s easy to see how someone might not be too quick to voluntarily add information about police involvement.

Parallels with COVID deaths

Khubchandani drew a comparison between the way police violence deaths and COVID deaths are reported, saying there are similar limitations. In a previous study from the same group of researchers, they estimated that COVID deaths in the U.S. and worldwide are underestimated because of the way they are labeled, he said.

Using COVID-19 as an example, he said a physician could walk into a clinic and say someone had a massive heart attack and died, maybe failing to note the person had the virus. So what was causing that heart attack would not be known. That creates some confusion, he said, unless they complete a full autopsy on the deceased person to determine the cause of death and any contributing or indirect causes of death.

“So statewide, nationwide, we have a bunch of columns and rows that the physicians have to fill in based on judgment, basically,” Khubchandani said. 

When someone is shot by police, he said, the cause of death is often technically bleeding or cardiac arrest, but the question becomes: Would that have happened if not for the police shooting that person?

Demonstrators memorialize people who’ve died, taking a knee for a moment of silence during an anti-police violence demonstration in August 2020 in Albuquerque, NM. (Photo by Marisa Demarco / Source NM)

RELATED: Study: Official statistics under-report police killings in New Mexico (Oct. 4, 2021)

Simple errors

There are other less ominous issues, too, simple errors that have nothing to do with social or job-related pressures. 

Different parts of the country label causes of death in different ways, Khubchandani said. What causes confusion, he said, is the difference between a direct cause of death and a leading or contributing cause of death, which is mostly based on a physician’s individual judgment.

The Lancet study also found another reason for under-reporting is errors in how the death certificates are recorded in databases. Many people are involved in the reporting process, Khubchandani said, and those who translate information recorded on a death certificate into codes for a digital database can end up making mistakes.

“It doesn’t always have to be an intentional missing cause of death,” he said. “It could be that someone was coding it and they wrongly put a code number. You always have multiple sets of opinion, probably away from any political police influence. We need extensive training for anyone who’s involved in this kind of labeling.”

He added that each state needs to require better training for people who code causes of death, specifically training on medical sciences, and they need to be part of an integrated team.

“This team should not have any influence and be more comprehensive and exhaustive in their analysis,” he said.

Physicians knowing that someone has been injured, and they don’t ask if police were involved, that seems like a major problem.

– Jagdish Khubchandani, NMSU professor

A national issue

The limitations in the police killings study could be addressed if the government did a better job of making their data publicly available, Khubchandani said. The National Vital Statistics System was only established in 2003, he said, which was too late.

“Now the challenge is that you really, really have to beg people to give you the data set, even if I have to analyze it,” he said. “It’s a complicated application that I have to send to CDC.”

New Mexico isn’t alone in this undercounting problem, and in fact, around the country the numbers are even worse.

The National Vital Statistics System is supposed to be the country’s most complete source of numbers for births, migrations and deaths, among others. But researchers found that in the count for the entire United States, more than half of all fatal police violence encounters — 55.5% — were missing. From 1980 to 2018, an estimated 30,000 people were killed by police in the U.S., but 17,100 were absent from the statistics.

How the U.S. stacks up

There are places in the world where police are less violent.

In the study’s conclusion, the researchers point out that other countries like Norway and the U.K. do not arm their police officers or only arm some select officers. The researchers stopped short of advocating for defunding or abolishing police departments.

“The difference these practices have on loss of life is staggering: no one died from police violence in Norway in 2019, and three people were recorded to have died in England and Wales from police violence between 2018 and 2019,” they wrote. “To respond to this public health crisis, the USA must replace militarised policing with evidenced-based support for communities, prioritise the safety of the public, and value Black lives.”

Khubchandani said there should be better systems and training for policing, some middle ground with a more sensible approach and training in de-escalation, and perhaps more rigid gun policies.

“I don’t think we are in a space where we could just defund or just abolish the police,” he said. “In the U.K., and Norway and a dozen other nations, the police don’t have a lot of guns and weapons. But that’s a different kind of society. And here, given that we have people who are armed, and the police deal with them day in, day out, they are in a tough spot, too.”

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Austin Fisher
Austin Fisher

Austin Fisher is a journalist based in Santa Fe. He has worked for newspapers in New Mexico and his home state of Kansas, including the Topeka Capital-Journal, the Garden City Telegram, the Rio Grande SUN and the Santa Fe Reporter. Since starting a full-time career in reporting in 2015, he’s aimed to use journalism to lift up voices that typically go unheard in public debates around economic inequality, policing and environmental racism.

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