Coroner Story: Cooperation

No dead bodies in this story. Though I felt like one at times. But I’m not dead yet.

I got a call, a message to the clinic where I was a daily, struggling family doctor in our small town. The prosecuting attorney wants me to come visit him.

I quickly racked my brain about my recent coroner cases. None I thought might be under consideration for prosecution. Had I missed something? Big gulp. Maybe a big oops here. I let his office know I’d be up to visit this late afternoon, after my last patient.

The courthouse is up on a tall hill overlooking our town. It has 1970’s architecture, so it is low, not tall and imposing. But there is the hill.

Close to the end of the day for county workers, so there was a spot in the parking lot. I slid the rusty Hilux in between a couple 4WD pickups.

The Prosecuting Attorney’s office is on the main floor. The secretary asked me to wait so I sat down. It was past five, so she must be getting overtime, I thought. Or maybe she did four tens. Maybe they didn’t come in until 9AM so they weren’t due to be off the clock. My mind jumps around like this when I’m nervous.

There was a picture of a barn on the wall.

James came out to get me. Big smile and handshake. He was in his second term in this elected position. I had just been appointed three years back. Both he and I would be on the ballot this coming fall. We all need to know our places. He brought me into his office, and I sat down. So did he. Behind the big desk.

There was some chit chat, then he got down to it. “I’m your attorney. As a county elected official, I represent your interests. So, I need to speak with you about your job as coroner and its obligations, your duties.”

“Yes?” Finally. Somebody is going to explain just what the heck I should be doing. I felt some relief.

He adopted a lecturing tone that seemed pretty natural for him. “Idaho code requires that you cooperate with other investigating agencies as part of your duties.”

Maybe I rolled my eyes. I hope I didn’t. I could see where this was headed. “I haven’t been cooperative?”

James looked down and shifted his elbows onto the desk. His voice was now softer. “I have heard from our sheriff that you aren’t always eager to investigate deaths that are brought to your attention.” Here he paused.

“If this is about his idiotic call to me about the landslide down in Juliaetta, yeah, that was bullshit. He calls me out with no information, no instructions to bypass roadblocks, and then when I get down there, there are no dead bodies, nothing to investigate. He called me out on a late Sunday evening on a wild goose chase. What part of me going to that bullshit scene does he call noncooperative?”

James shifted a bit.

“Or is there some other dereliction I have committed? If you ask me, he’s the one not cooperating. He isn’t sending detectives to scenes of unexplained deaths. Did he mention the one out past Bovill? Look, he’s got the budget. He’s got the personnel and the resources to investigate and document, keep evidence. He’s the one should be leading on these, not me. I got squat.”

James looked me in the eye. “This is all news to me. He said you weren’t cooperating, so I said I’d speak with you.”

I just shook my head. Not cooperating.

James did the big sigh and spread his hands wide. “I know you are busy. You run your practice and all. But maybe this would be better if you and him had a talk. Make some time and you sit down with him. It is indeed in the Idaho law that you should cooperate in your investigations. But relationships take time.” He beamed, the peacemaker.

I reflected. My spat with our sheriff down on the Potlatch River blow-out was the only time I had any direct contact with our fellow elected officer. The people put us here. “You’re probably right. I’ll meet with him.”

James beamed. “It would be best that way, since you outrank him and all.”

“What do you mean?”

James chuckled. “I guess you don’t read all the statutes about your duties. You are the only one who can arrest the sheriff. And if for some reason he is incapacitated, absconds, or is arrested, you become the acting sheriff.” He was goddam grinning at me.

“No way.”

“Yes way. It’s the law.”

He chatted me out. With his hand on my shoulder he offered, “I’ll have my clerk look up the sections of Idaho Code that pertain to your office and duties. You should be familiar with these statutes. We’ll get those to you. This will save you all the searching around.” He almost winked.

Did he know there was some ambiguity here? Did he know the depth of my ignorance? Probably both. I chatted on out. I had met the prosecuting attorney and left feeling a fool. But that is my nature. The Hilux awaited.

The folder of photocopied Idaho Code came to me in a couple days. I read the Articles and Sections and Chapters. Could they possibly make it more confusing? From my reading it seems nobody in an elected position wants me, the county coroner, to know how I’m supposed to do my job, at least in the twisted, arcane laws they write.

Maybe they think I should know my responsibilities since the people elected me. If so, I’m beginning to lose some faith in our democratic institutions, from the perspective of an appointed county coroner who has now learned I can arrest the sheriff. But the voters will decide soon. Maybe I am unfit. Would they know?

In the meantime, I asked to meet with our sheriff. I had said I would, so I did. It took some back and forth and I had to cancel a couple patient appointments, money out of my pocket. He’s on the taxpayer’s dime. But I guess he was pretty busy. He fit me in.

The sheriff’s office is in same the county courthouse as the prosecutors. I knew the place well, since I was also the doctor for the jail, which was in the basement below the courtrooms and the sheriff’s office. I had been there many times. Getting that job is another story. I’m sure our sheriff knew this since the county sent me a meager monthly check for my oversight. I was cheap. Maybe he saw that as a weakness. I’m jumping around in my mind as I nervously wait.

 I sat in the reception area as requested by the uniformed female deputy. She was attractive. My thoughts again bounced around to too many places as I took my seat. No magazines, some wanted posters on the far wall, it was before smart phones, so I just sat there and looked around. A few desks with just the pretty deputy right here in front of me. And then the door to the sheriff’s office behind. Walls covered with metal file drawers on all sides. Back in the far southern corner was a door to the detective’s room. I had been there once to talk with Earl. I didn’t see him, nor many coming and going. It was pretty quiet.

The sheriff came out to get me. He greeted me warmly with a handshake, but I could see a tall deputy in his office. I was invited to enter. The tall guy was the same asshole from the Juliaetta mudslide. He stood with his broad shoulders and erect posture at the east window. I went to introduce myself and shake his hand, but he dropped both hands to assume the position of attention and looked off into the not real distance. Like he wasn’t to be acknowledged.

“I just asked Deputy Dobbin to join us as an observer.” The sheriff offered. Observer?

“So, Coroner Hawthorne, what brings you to our humble office?”

Lob. “I thought it would be best if we met in person, not at a scene, to improve our sense of cooperation.” Lob with spin.

“Yes.” He folded his hands and looked down at his very big desk between us. “And how could we cooperate better?” Deputy Dobbin rested his attention pose a bit, though he didn’t assume parade rest.

No point further dancing. “Sheriff, you have all the resources, detectives and equipment and evidence security to investigate suspicious deaths. I got nothing. So, when a death is suspicious you should be assigning your resources. If you want just the coroner to be investigating suspicious deaths in this county, I’m afraid we could miss something. We are required to cooperate in Idaho Code. I am here to ask for your cooperation in death investigations.”

He smiled and shook his head. “You are suggesting I spend taxpayer money on cases that you should be investigating. How does that serve the public?”

I hope I didn’t roll my eyes, but I might have. “Deaths sometimes need investigation. I’m very comfortable with my role. But sometimes, having a sheriff’s detective involved really helps. Can’t you see that?”

He shook his small balding head again and smiled down at his huge desk. “I’m hearing here that you just don’t want to do your job.” Here he looked at me directly. Deputy Dobbin came to his full height off to the east.

So, cooperation might just be off the table I assumed at this point. “I’ll do my job, if you’ll just do yours.”

Deputy Dobbin interjected his commanding tone I had heard down in the canyon. “The Sheriff is clearly doing an excellent job.”

But I was looking at the small balding man behind the big desk. He was moving his fingers around in a circle on the clean desktop. “I serve the county taxpayers. If we spend their tax dollars on death investigations that are your responsibility, then we have less money to protect them from the bad guys. If you’d do your job, we’d all be better served.”

“Can you give me an example of when I should have investigated a death that I didn’t?”

Here he smiled and looked at me directly. “I’m not here to criticize your performance. And I don’t believe you are here to criticize mine either. You said cooperation was the goal. So, let’s cooperate. You do your job and I’ll do mine.”

He wasn’t dismissing me, but almost. So, I took what I expected was my last shot. “Sheriff, you have the resources for good investigations. I don’t. If a death needs that level of investigation, I would appreciate you authorizing those resources. I don’t want to be left out on my own. I’m afraid we could be doing the citizens a disservice.”

He was standing and coming around the big desk. Again, I was shocked that he was shorter than me. He was smiling, like he had won this duel. “I’m sure you will do your job, just as I have sworn to do mine.”

I left the office knowing this was not going to work out. I felt like a weak pissant to his authority. Welcome to this democratic institution. I knew I had failed to persuade.

Our cooperation was dead.

Manner of Death: ineptitude

Cause of Death: weakness

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EMTALA

The Emergency Medical Treatment and Active Labor Act (EMTALA) has been in the news recently. The Biden Administration has sued Idaho over our restrictive antiabortion laws, claiming the Federal Act trumps the states restrictions. Oral arguments were heard before the US Supreme Court this week.

So, let’s step back a bit and try to understand just what EMTALA says.

The law was passed by Congress and signed by President Reagan back in 1986. There were many stories at the time in the press and professional testimony telling stories of patient “dumping” between hospitals.

A patient with no health insurance might show up at an emergency room. Let’s say the ER is in a private hospital.

If the city had a public hospital, like LA County Hospital or Cook County Hospital in Chicago, the private ER would just send the patient down the road to the public hospital without offering any treatment. That is, they performed a “wallet biopsy” and determined they wouldn’t get paid, so sent the patient off to a publicly supported facility.

There were also cases of pregnant women in active labor being shunted off. Tragic outcomes were reported.

Congress acted. Not to fix our messy health care system, just to make such dumping cases sanctionable.

Congress put the Centers for Medicare and Medicaid in charge of enforcing these rules.

EMTALA violations are investigated, and fines are levied. Every year 3-4% of US hospitals are fined. Private, for-profit hospitals have twice the incidence of violations as do nonprofit hospitals. Fines average about $34K per incident.

So, dumping still occurs, I guess, but it just doesn’t stir the outrage it used to.

EMTALA prohibits the transfer of patients based on their ability to pay. It also required patients receive stabilizing treatment before transfer. Indeed, the emphasis on “stabilizing treatment” in the law is at the crux of the Biden Administration lawsuit against Idaho’s antiabortion laws.

I am not a great fan of the Federal EMTALA law. I think it responded to outrageous behavior with bureaucratic hand slaps. Indeed, the cost of healthcare went up after EMTALA. More cost shifting onto insured patients occurred when hospitals were required to provide uncompensated care.

 But it was enacted to put a band aid on our bleeding health care system. Uninsured patients were being treated inhumanely. So, dumping them gets a fine.

Instead, we should have made sure all had health insurance.

Back when EMTALA was passed about 17.6% of the population was uninsured. In 2022, we have gotten down to 7.9%. EMTALA didn’t give anybody health insurance. It just brought civil penalties, fines to violators.

The public and Congressional moral outrage at hospitals denying care based on the patient’s inability to pay lead to EMTALA. But we still have uninsured. We still have the most complicated, mind boggling health care system in the world. Maybe you think it’s what makes America great. I don’t.

Whether the US Supreme Court will decide Idaho’s antiabortion laws violate EMTALA has almost stood the purpose of the law on its head.

Idaho is arguing our laws, to DENY CARE take precedence over the Federal requirement to provide care.

Specifically, in Idaho, if a pregnant woman comes to an emergency room and is unstable due to conditions of pregnancy, she cannot be treated with an abortion, that is, delivery of the fetus that likely will not survive, unless it is to save her life. If she is bleeding, infected, unstable, and the recommended treatment to save organs, her reproductive future, she cannot receive this treatment in Idaho. She must be transferred to a state where such treatment is legal. Six such transfers have occurred since our laws went into effect.  Idaho is dumping our unstable pregnant women on other states.

Little wonder that doctors who treat pregnant patients look at Idaho with trepidation. Such a determination puts them very close to, if not over the line of “do no harm”.

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Pit Toilet

My wife and I just finished a 5000-mile trip across this country in our 1985 Volkswagen Adventurewagen. We saw a lot of farm country and small towns, since we avoided most interstates. We camped in a lot of nice little parks that most people fly over.

We always commented about the toilets.

It was a bit early for most parks to turn the water on. We had 2” of snow in Mobridge, South Dakota. It was freezing in Rosebud, Montana.

But the pit toilets were open for use. We had a shovel but didn’t have to resort to that.

The pit toilet at Far West, where Custer left the steamboat for the Little Big Horn was inspirational. It was very clean and had a poster on the wall. “Let gratitude wash over your experience.”

In Ohio, a sign above the toilet forbade trash disposal, as many do. “It is extremely difficult to remove.” The half dozen plastic bottles below told me something.

Pit toilet ethics are worth consideration.

Pit toilets have a specific construction that is best enabled when the door is closed and the seat on the throne is closed. Most toilets have such a sign inside. It seems only respectful to follow such advice. Most people do.

Pit toilets are the alternative to flush when water or septic doesn’t suit.

 I remember when my favorite road stop on the Salmon River switched out their flush toilets for pit ones a few years back.

Flushing is what we are used to. We all love it. But this site was just above a treasured river. Septic drains downhill. Pit toilets get pumped. I came to appreciate this choice.

How we treat each other is reflected in these ethics.

I remember reading about the Mormon Trail. These westward travelers left firewood for the next party and had their latrines downstream from their camp. It was in their ethics, their values. They got less typhoid. I appreciate such values.

It might seem a frivolous writer’s obscure segue to come around to the Idaho legislature about now, discussing pit toilets and septic systems. But permit me.

We elect these folks to do the duty of taking care of issues for all of us.

I am here arguing that the Idaho Legislature has left the seat up on a mess they have made. The smell is evident.

Idaho Republican legislators have acknowledged that their abortion statutes are a mess. Idaho House Health and Welfare Committee Chairman Vander Woude said, “OK, now we have to take a really close look at the definitions.”

But they didn’t.

Vander Woude cancelled the public hearing of the joint Senate and House Health and Welfare committees to hear from medical providers about how their mess was affecting health care for Idaho citizens.

The Idaho legislature left the seat up as they walked out of our pit toilet. What does that say to you? I find myself disgusted by such behavior.

When you walk into the pit toilet and the lid is left up, you might find yourself muttering curses against the last guy before you.

But in this case, the last guy has an excuse. He was told to leave the lid up.

It turns out our Idaho State Attorney General directed his fellow Idaho Republican colleagues to walk away from solving this stinky problem. He wants to make a name for himself as he argues his case before the US Supreme Court.

This has indeed become very stinky.

It should not be so.

If folks, our Idaho Attorney General and our elected legislators would have just lowered the lid on their mess, this pit toilet we share might be less unpleasant.

But they chose not to. They left the lid up.

Think about the pit toilet of Idaho politics. And let gratitude help you vote.

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Medical School

I attended a town hall meeting with two of my elected legislative representatives a while back. Only two of the three who represent me were in attendance. The absent was my State Senator, Dan Foreman.

He beat me in 2016 (Trump-Hillary), then lost in 2018, probably because he couldn’t control his temper. But he bounced back. Maybe he’s figured out public interactions don’t suit him. That’s just Idaho Republican politics.

Instead, I want to talk about another of my representatives.

Representative Brandon Mitchell voiced an interesting idea. It’s an old, tired, worn idea that might have some credibility, given Idaho’s recent explosive growth. But I doubt he has much understanding of the history of this idea.

He suggested it might be time for Idaho to be considering establishing its own medical school. This is a guy who represents a district where there are currently 80 medical students residing. All are tax-paying voters, I presume.

Idaho shares in a consortium with the University of Washington School of Medicine. That consortium is called WWAMI, which stands for the participating states: Washington, Wyoming, Alaska, Montana, and Idaho. The states shell out cash to UWSOM to make medical school seats available for their residents. Applicants must prove their Idaho residency, then get charged in state tuition for their four years of training. Idaho taxpayers shell out the difference between tuition and the full cost of the education.

This program started back in the 1970’s. Full disclosure, I am a graduate of this program, back in the stone age. We puked and bled our patients.

But Representative Mitchell’s idea might possibly serve Idaho if we had any kind of sticking power.

But it would definitely not serve his district. Maybe he’s seeing the bigger picture. I don’t really know. He doesn’t respond to my emails.

I just drove across South Dakota. It has less population than Idaho and its own very decentralized medical school. It proudly claims to produce doctors for their rural needs. I googled the heck out of their budget documents but could not find what South Dakota taxpayers fork over to fund this program.

They must be happy with it.

Wyoming wasn’t. They had a medical school for a while but dropped it to become the second “W” in the WWAMI program. It was too expensive, and they weren’t getting the product they needed. States should be critical about how they spend their money and pay attention to what they get for the dollar. Wyoming was and joined WWAMI.

Idaho should be critical too. But what do you count?

Idaho’s current yearly funding for WWAMI is about $7.5M. That supports 40 Idaho medical students a year. These students also pay their share of their tuition coming to $55K a year per.

For South Dakota medical students it’s only $32K a year.

You can see that the numbers are piling up here. And we haven’t even discussed the cost of a cadaver lab.

Facilities are the capital costs. But, if you build them, maybe they will come.

Remember, Idaho already has a private, for-profit medical school subsidized by Idaho taxpayers because of a cheap, 60-year lease agreement made by our previous governor.

Idaho College of Medicine is down in Meridian, churning out Doctors of Osteopathy. Their tuition is significantly less than UWSOM. They seem to be doing great. Why isn’t this the model we should be following? Capitalism solves all public needs through the invisible hand, right?

Only WWAMI graduates are required to come back to Idaho, under current law. Doesn’t that solve our shortage? Unless we keep driving them away, maybe.

Will Idaho doctors be from UWSOM taxpayer supported, or ICOM, the free market variety?

These are twisted concepts that require vision.

Representative Mitchell’s idea to build an Idaho medical school will send 80 of his voters to Boise. And all the funding that goes along with them.

Who is he working for? Not his district.

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Who Pays?

I can understand that the Idaho Republican Party and our Attorney General Raul Labrador like their closed Republican primary election. I just wish they didn’t expect all of us Idaho taxpayers to pay for this “good old boys” clubhouse they have built.

You know us taxpayers paid the construction costs, don’t you?

First, we paid their lawyers.

Back in 2011, the Idaho Republican Party sued the State of Idaho. There was infighting then, as there is now amongst the R Party about whether their primary should be “open” to all who want to vote, or do they have to show “club membership”, i.e., be a registered Republican. 

The Idaho law back then required open primaries.

But then the Idaho Republican Party sued itself, oops, I mean the State of Idaho about whether it could have a closed primary or not. The Idaho Republican Central Committee passed its rule for closed primaries back in 2007, but it didn’t have enough control in the statehouse to get the law changed, so they filed a federal lawsuit. They won in Federal Court.

Whether that was the right or wrong decision is worth a few other columns, but it was the court’s decision.

And the Idaho Legislative Republicans then voted to pay the Idaho Republican Party lawyers’ $300,000 legal fees. Straight out of the Idaho taxpayers’ pockets straight into the Idaho Republican lawyers’ pockets. How does that make you feel? I get a greasy feeling, like after a week of camping without a shower when I think about it.

That was the first payment.

Now we taxpayers pay yearly rent to the Idaho Republican Party for them to keep a private clubhouse on the public dole. We buy with our tax dollars the voting machines they get to use in their club’s closed primary election. All of us taxpayers pay the salaries of the State and county officials who run and monitor the Private Republican Party elections with our tax dollars. We keep a taxpayer funded public list of their club members.

There’s a public list of Idaho Democrats too. I’m amazed Dorothy Moon hasn’t called for expelling all us Idaho Democrats yet.

Private clubs like the Idaho Republican Party aren’t and shouldn’t be illegal. Heck, they often do good for their communities. I’m sure the Rotarians and the Lions clubs are great organizations. I don’t mind paying for my lunch or contributing to their plate when I attend one of their meetings. But my tax dollars shouldn’t be siphoned into their coffers. The Idaho Republican Party has its hand in the Idaho taxpayer’s pocket.

 Maybe this is okay with you out there because you’re an Idaho Republican. You think the amount of good you’re doing for the State of Idaho is worth the cost. But your private clubhouse must be built on principles. I believe it is. You have a noble, high-minded if not wacky platform. I don’t see anywhere in there where you support public funding of private clubs.

Let’s step back and look broadly. It’s only fair.

Every expense the state or county lays out for the Idaho Republican closed primary is also laid out, in a much smaller proportion, for the other political parties. Us half dozen Idaho Democrats get to vote in our publicly funded primary.

But we don’t require club membership. We allow anybody to choose a Democratic Primary ballot, even if you are unaffiliated with any party. We are not a private club, just a small public one.

This is why primary elections in Idaho should include everybody. Because we all pay for it. Even people who don’t vote pay for it.

But the Idaho Republican Party is getting away with keeping their primary private, “closed” in their terms, and still getting public support to run their elections.

If this sleazy behavior makes you feel dirty, there’s an initiative soon to be on the ballot I need to tell you about.

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Mature

When I’m feeling old, I try to consider that I am mature. That means I have aged, not become decrepit. Maybe wisdom comes with maturity. Perspective is everything.

Idaho needs some maturity. We have aged as a state, and recently we have grown. We have not matured.

I first began considering this as I watched the legislative oversight committee on Child Protection. You can see their hearing online. It’s worth watching.

The committee, and their citizen partners were very frustrated with how care is being provided for our foster children. One Senator even asked for heads to roll.

They may. But is that a mature response? Sometimes it is the right one. But I like to consider systems.

I have asked for the funding and enrollment history for foster care from the Department of Health and Welfare. Even though I am a Board member, I have not received it. I will continue to study this. But I need some more information to really understand the problem. I hope I get it. If not, I can see why heads should roll. That’s the reaction I feel when frustrated.

Then I got informed of another very interesting study with lots of good information. The Idaho legislature directed their stellar Office of Performance Evaluations to look into Idaho death investigations and coroners.

This is close to my heart.

I was a county coroner for 15 years. I saw the poor performance we were doing investigating deaths in Idaho, me included.

But we are the wild west out here, aren’t we? I didn’t wear a Stetson or ride up on my bay mare at a death scene, but I often felt like it.

Frontier justice might satisfy frontier times, but it doesn’t serve a mature state. It’s time we decide if we have passed puberty.

The report, and many other good reports from OPE are available online. You have broadband, don’t you?

The short story about death investigations here in Idaho is that we are dismal. We do the least autopsies of child deaths of any state. This state that claims to revere the life of the child (maybe only the unborn?) doesn’t seem to want to know why the child has died.

We were the last state in the union to establish a Child Fatality Review panel. It was only put in force by Governor Otter’s executive order. And since it was an executive order, the panel cannot subpoena records. They can politely ask county coroners for their reports, but refusal is allowed.

Did the county coroner do their job? Do you, the electorate even care? If a child dies, shouldn’t the cause of death be a concern for the state?

It sure is if it’s in an Idaho woman’s womb.

Idaho has not grown into the maturity of seeing the whole system.

Children dying is worth protection.

Our state has the most restrictive abortion laws in the nation. Our legislators are very proud of this.

They should be ashamed that they do not care to protect the lives of children out of the womb.

As I said, I was a county coroner. Children in my county were killed. Children in my county died. It was a tragedy. I did my best to investigate. But I was on my own.

Investigating is the first step to understanding.

The Idaho legislature seems to be very preoccupied with protecting children from books in libraries. But they seem to have no concern for children who die.

Unless they are inside a woman’s uterus.

A mature response to this would not be a flurry of laws or resolutions. We see enough of this from our immature legislators.

Instead, we need to understand the systems and change them. That would be a mature response.

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Coroner Story:Visqueen

This call came in the late fall. Darkness would come soon. So, I set out before finishing my dinner with the girls. Martha would care for them. Light will fade.

The sheriff’s dispatch lady said there was a dead body I needed to investigate out past Bovill. That’s a 45-minute drive to the east.

“Is there a detective there? Can I call him?”

“Just a patrolman sir. The sheriff didn’t assign a detective.”

He was a new Sheriff, and we weren’t getting along.

He did this to me for his four years in office. He even got a friend of his to run against me. We each have four-year terms, mine alternated two years before and after his. But he smiles and talks to me friendly now when we pass in town. He only got the four years, and I quit long after he was gone.

It couldn’t have been partisan animosity. I ran unaffiliated, no party attached to my name on the ballot. Maybe he just didn’t like me. Indeed, we hadn’t met until a few weeks ago.

The blowout down by Julietta might have fixed it.

That was another late evening call a few weeks back. I had gotten a call after dinner from the sheriff’s dispatch that I was needed down in the canyon. No details, just that I was to go to a scene. So, I took off in my rusty Toyota Hilux.

When I made the turnoff in Troy, there were barricades in the road. “Road Closed”.

I went around them like a kid sneaking candy. Then I drove on at 40 mph when I could have been doing 55, maybe feeling guilty.

When I got down to Kendrick and needed to turn right there was another barricade in the middle of the two-lane. “Road Closed”. Very serious, I guess. But I sidled around this one too and went on. The little Hilux fit around such obstructions.  Duty calls.

When I got to the scene it was in fact pretty impressive. Lots of lights, bulldozers, a mash of mud and big basalt boulders across the two-lane highway. I parked and got out. I walked forward, nodding to the deputies I knew until I saw our Sheriff. I went up to him.

I only knew him from his pictures in the local paper. He probably didn’t know me. They never ran the coroner’s headshot.

But then, maybe he did.

He had never introduced himself or called to talk to me. But I hadn’t done that either. I got paid $500 a month with no benefits to do my job, and he got a full-time salary, five figures with health insurance.

But here’s the kicker.

The coroner is the only one who can arrest the Sheriff.

If the sheriff is for some reason subject to arrest, the only person in the county who can do that is the coroner. And if the sheriff dies or absconds, the coroner becomes the sheriff. It’s some sort of chain of command thing. I didn’t know this at the time. I would later. Idaho laws are mind boggling.

I had found out about sheriff summons in my first years, before I had to deal with this guy. I wasn’t even sure what a summons was, but the previous sheriff had the decency to inform me.

Phone call came between patients: “Doc, you’ll get a summons for me tomorrow.”

“Huh?

“I’m being sued, and the summons server will bring the summons to you and then you are supposed to serve me with it.”

“Really? Serve?”

“Yeah, that’s how these things work. I’ll have a deputy down there so you can just give it to him, and he’ll give it to me. Save you the hassle of coming up the hill.”

“Is that legal?”

I heard him exhale and I imagined his girth in his chair. “It follows the spirit of the law, let’s say.” So that’s what I did. Seemed pretty civil.

Serve?

So maybe this sheriff’s animosity was out of fear. But then he would have to be doing something wrong, wouldn’t he?  I didn’t know, despite the summons thing, at the time that I outranked him. I don’t know if he knew this. But I did come to learn this clearly later on. Not then, not at that time in the Potlatch River canyon. I just walked up to him.

It was unbelievable that he was shorter than me. I have always dealt with taller teammates. Basketball, football, volleyball, me being 5’8” doesn’t make me substantial. We have to find other ways.

“Hello Sheriff. You needed the coroner?”

He turned to me, looking away from the bulldozers. He didn’t seem to recognize me but smiled and shook my hand. He looked absent and didn’t say anything. It was like we were at a wedding, and three drinks in, he was meeting a distant relative.

“Hello, my name is Sid Hawthorne, and I am the county coroner and you requested I come to this scene.”

He focused a bit. “Oh yes. Some people were killed in this landslide.” He waves off toward the mud and bulldozers.

“Should I look at them?”

“Uh, no, they’ve been taken off to the hospital in Lewiston.” His vague goes up a bit and he turns back toward the bulldozers.

The hillside and scene are illuminated by the mobile lights, and the multiple generators and heavy equipment are filling the deep valley with their noise. But I notice a tall deputy coming toward us behind our diminutive sheriff.

He’s got the swagger. He stands behind the small man with his hands on his hips, glowering down at us two small men below him. I am the object of this glower.

I too appraised the muddy scene. It looks like some significant uphill precip had washed a shit-ton of Palouse mud with some basalt rubble downhill. And I could believe a car on this road might be a casualty.

“Where’s the car?”

The sheriff still looks absently at the bulldozers, like he doesn’t hear me. I wait and take a breath to repeat with a louder voice and the tall deputy intervenes.  “It’s up here.” And he turns and strides toward the generators and noise and mud.

I follow.

Below the road is more mud and a very muddy vehicle on its side. I can’t even make out it’s color or type. In my memory it’s a 1938 Packard, but that’s got to be wrong.

“They got them out of there?” I’m incredulous.

The tall deputy looks down on me, imperious. “The bodies were recovered. They have been taken to Lewiston.”

I turn away from him and walk back to the sheriff. He’s still gazing at the heavy equipment. When I get to him, I speak loudly, so I can be sure he hears me. “You called me out here to come to a scene and these bodies are not even going to be in our county jurisdiction.”

He slowly pivots his absent gaze toward me, probably not remembering just who I am.

“You don’t need a coroner.” I yelled at him over the generators and bulldozers.

The sheriff says nothing. But the tall deputy asserts himself. “We don’t need your complaints while people are out here risking their lives,” and he waves back at the bulldozers.

I turned and walked back to the Hilux. This would not be the end of me and this sheriff. And his deputy.

Pissing contests between elected officials don’t end well. You will see.

So now I’m heading out to a dead body out of Bovill, with no detective. And Mr. Sheriff is probably finishing his dinner and starting into nightcaps. Or maybe, he’s well past the beginning. Can’t we get petty, us public servants?

I turned north in the hamlet as the dispatcher had indicated and looked for the mill, but the western light was fading. I saw no mill. But ahead of me was a long straight stretch of road going north so I slowed down. It should be close. There was a track to the right and some trailers. I turned in. There was a county patrolman’s rig parked toward the end of the track past the trailers. I had found it.

He was standing by his rig. I’d met this guy before. He was solid.

“So, what have we got?”

He stood with his thumbs on his belt and told me what he knew.

The guy was employed to tear down the mill. He ran a cutting torch all day to cut through the steel beams so they could be sent off for scrap. He had squatted here in his hooch at the end of this lane for the last couple weeks. He hadn’t showed up for work today. No one from work had come to look. But the lady in the last trailer here had noticed he hadn’t come or gone and called it in.

“So, she called you guys?”

“Yeah, a welfare check.”

“So, you were the first to find him?”

“Yeah.”

“When was that?”

“About five.”

“So, you’re getting overtime?”

He looked at the ground. “Naw, Doc. That’s not been approved. I just stayed because I found him, and I thought I should be the one to talk to you.”

I looked at him and shook my head. We shared a grimace. New sheriff.

“You got his ID?”

“Just his name from the mill contractor. I didn’t get his wallet. Waiting for you.” “Well, thank you for this. Is there anything you have seen you think I should know?”

“Not really. Just poverty.”

I look intently at the young patrolman in the fading light. I worry he might be a Democrat in law enforcement. I go elsewhere. “Have you talked to anyone else?”

He also looks to the western fading light and nods toward the closest trailer. “She came out and said she was who’d called it in. Said she was worried about him.”

I pause. “Anything else? Drugs? Guns, alcohol?”

He smiles a small smile. “Not really.”

“No foul play?”

He slightly gusts a laugh. I’m treating him like a detective, and he knows, and I know he isn’t. “Not that I could see.”

I look down again, though the darkness hides the dirt at our feet. “Thanks, I’ll go look.”

I head back into the trees toward the end of the lane.

His hooch is visqueen.

Black plastic sheeting formed into a tent between trees, strung with cord. There is a small fire pit outside his tent with some garbage around it. No booze or beer bottles, but I notice some cigarette butts. I don’t see any roaches.

I raise the plastic flap and the first thing that impresses me is his size. Lying on his side, his body almost fully occupies the weak plastic tent. His left arm is under his head, and his face is black. It’s not a black I had seen before.

If it weren’t for the black, I’d say he might have appeared peaceful. Death doesn’t turn the face black. Black comes in death, but not to the face first, not in this position. And not that color. It was like he had bent over a sooty fire. And indeed, he had, for days.

There were little votive candles in front of him, now burned out. He had a weak sleeping bag, but no real pad beneath him that I could see. There was no way I was going to be able to move him. From my perspective he was 350 pounds plus. I looked down at his arm under his head and protruding toward the little candles. His forearm was bigger around than my calf, his upper arm like my thigh.

It had been cool in the days, and pretty cold at night. The chill was coming on as I looked at him. He did not stink, and he wasn’t bloated, just huge. I bent down and tried to move his upper arm that laid along his mass. It was stiff, full rigor still, though the fingers were loosening.

I do the best I can to get his wallet from his pants pocket. The denims are so dirty they feel like oiled canvas. He has ID and three dollars.

I went back to the deputy. “I’ve done what I can. Here’s his wallet. Name fits. Could you call dispatch to have the funeral home come pick him up?”

“Sure thing.” He gets on his radio.

“Make sure you let them know his size. Might take a couple people to load him.”

He nods to me between the radio conversation.

I wait till he’s finished and say, “I want to go talk to this lady here.” I nod at the trailer. “You don’t have to wait for the funeral home. You can go.”

“I’ll be OK.” He says.

“I’ll be here. You can go.”

He shakes his head. Some guys are real solid. I hope they last.

I go toward the trailer. Single wide up on blocks with straw bales around it. Warm lights inside and the porch light on. I knock.

I can hear the steps inside, solid but slow. When she opens the door, I can hear a TV in the background. She’s big too. “Yeah?” she croaks out.

“Hello. I am Dr. Hawthorne the county coroner. You called in concerning the man in the hooch out here. Can I talk to you about that?”

“So, he’s dead, huh?”

“Yes ma’am.”

She exhales like she might have been saying “Sheeeiut” and follows with, “Come on in.” She moves away from the door, conveying my entrance.

I step up and in.

It’s cozy, but small, though, like I said, she’s big. She has moved to the room with the TV, though she politely shuts it off and then sits in her throne, the recliner. I stood. The small kitchen was behind me. It was neat, though the floor vinyl was pretty worn. Hell, it’s a trailer. The hall heading west would be the bathroom and bedroom. I wondered for a second about septic but let go of that.

“So, you knew the deceased?”

She lit a cigarette. The ashtrays were frequent and full. “Yeah, I knew him. He came in here a couple weeks back and set up his camp.” Her voice is like an idling McCullough.

“He was working at the mill?”

She took a drag. “Yeah, cutting steel for them. Ran a torch all day. Tearing the place down.” Another puff. “You see his black face? Cutting steel with that torch. He warn’t no nigger!” and she laughed loud and exhaled toward the ceiling.

“Had he seemed sick recently?”

Here she paused. Fiddled with the ash and looked down. “Yeah.”

She paused, so I did too. Leave space.

She looked both ways fast like something had passed, then, “He was just trying to get by. They didn’t pay him shit, but he thought if he could get this done, he’d get his own trailer down in Nevada.”

“That’s where he’s from?”

“Hell, I don’t know. But that’s what he said. Nevada.” And she did the looking both ways thing again.

Pause.

“How did he seem sick?”

Long draw and she stared at me with the inhale. “You know.” She glared. “You’re a doctor, ain’t you?”
I looked down to the worn vinyl and laughed a bit. “Ma’am, I am only getting to see this man after he is dead. I am asking you to tell me how he seemed before he died. Your observations will help me understand this.”

She exhaled toward the bathroom and continued her glare at me. We paused together there for a while.

“When he first came, he asked about squatting there. I told him about the landlord. Didn’t think he’d even know, lives in California. So, he set up.” Another puff. “We would have breakfast. Cooked another egg for him. I got to know him some. Damn, he worked hard.” She shook her head. “And now you want to know why he died?” The glare.

I smiled, as soft as I could. “It sounds like you knew him some.”

She waved the butt before her. The pastel housecoat covered her chest and breasts and belly and thighs. Her round, worn face, framed with oily stringy hair softened from her grating pronouncements. “Yeah, I knew him a bit.” She looked me in the face. “It was that work that killed him. Sure, he was fat, but then so am I.” And she laughed like a choked chain saw. “But running that torch all day, breathing in those gases, that’s what did him in.”

“So, he was having a hard time breathing?”

She laughed, and then coughed, then spit sputum into a Kleenex. “Hell, honey us fat people always have a hard time. I offered him my CPAP.” She laughed soft for a while.

“Did he have a fever these last few days?”

She seemed to jolt. “You know, he might have. Sweaty for dinner.”  The both-ways look again. Was this sincere or just her feeding me what she thought I wanted? Get me out of here.

“So, he seemed sick last night at dinner?”

She stubbed out the cigarette. It took a great effort to shift that body forward. She concentrated, then shifted back, coughed a bit, shallow and nodded. “It’s not like I knew he was sick or nothing, Doc. I just noticed he was weaker, slower, and he was sweaty at dinner last night. He didn’t eat much. He said he was feeling tired.” She stared at me with both her hands on the armrests.

“I guess I should have looked after him better.”

Here, I looked down to the worn and chipped floor. I shook my head. “Ma’am, I don’t come here to burden you. I am glad you could get to know him some. It sounds like he was a hardworking man living on the edge. Maybe we all should look after each other a bit better.”

Still standing, but done now, I looked down again at the vinyl squares. “Thank you,” I said to her, looking her in the eyes. And I let myself out.

The deputy stayed, I guess, until the funeral home came. I was gone by then.

Cause of Death: Pneumonia

Manner of Death: Natural

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Deal

It seems Republicans everywhere want to have work requirements for people who receive Medicaid health insurance. Our governor has said he’s on board, as has the interim director of the Department of Health and Welfare. The legislature has long argued for this, and they are again. Idaho has a request pending. It has not been approved by the Trump administration or this Biden one.

I understand their concern. Why should us taxpayers give our tax money to folks loafing on the couch all day? If that’s the case.

I first ran into this sentiment when I was campaigning for office. The local laborer’s union gave me a chance to make my pitch to them. Democrat, Union, you’d think we were simpatico. Maybe not.

I introduced myself and then asked them what they wanted from the state government. The young guys were reluctant, but finally a guy spoke up. “Why don’t we drug test people who want welfare?”

I told him I would look into it. After I got elected, I did.

Some states had imposed this testing. It had become a meme. That is, there was widespread belief that druggies were taking our tax dollars.

The actual numbers showed that the cost of drug testing and the administration of this requirement had added significantly to the taxpayers cost of the program. Further, the number of folks using drugs on Welfare was well below the number of the general population. So just what is your point?

I believe most folks do not want to give something out through government-imposed taxes to another of their fellow citizens who might be undeserving of their generosity. I understand this sentiment. And I’m an Idaho Democrat.

But the laws we write are supposed to promote domestic tranquility and the common good. Anyone remember that?

So, let’s look at the work requirement proposed for Medicaid health insurance.  Idaho’s proposal has many exceptions for “work”. Caretakers, moms, folks recently unemployed are exempted. So, who might be abusing this government benefit? I would argue, it’s a very small fraction of the Medicaid population.

I guess you want to build a department of government to look for these scofflaws and make sure they don’t have health insurance that we are all paying for.

Given our current system assumption that health insurance is a work-related benefit, it makes sense that we should be pushing people to gain employment, and then their health insurance would be the employers problem, not us taxpayers.

So, here’s the deal I offer you “work requirement” afficionados. And I believe it is a plan that would be accepted by our federal partners. Neither Trump nor Biden have approved our current proposal.

Idaho should propose to the federal government, our Medicaid partner since they pay 70% of the bill, a study.

We get to impose Medicaid work requirements on half of the folks who apply for Medicaid. We study this half, and the half that don’t have the requirements. We watch them for their long term, let’s say five years, outcomes. How many become employed and off the dole? How many just stay uninsured and a burden on us all.

Do we really help anybody with this program?

I have my bias.

You probably do too.

Let’s study the question.

It comes down to the question of whether you believe people, our society, your neighbors, all of us, are better suited to serve the common good if we have health insurance.

Since the health insurance industry is a significant portion of many people’s retirement portfolios, I doubt any major disruption is in the cards.

But if you want to drain the swamp, this is a good place to start.

Let’s make a deal.

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Coroner Story: The Scene

It’s not that I have anything against mobile homes. Folks gotta have a place to live. But I’ve had some bad experiences in mobile home parks as the county coroner. Is it the nearness to poverty? Is it the thin walls and lack of privacy? Is it the mud and detritus we pile up and our neighbors observe and resent? I can’t say I know. But I have seen some of it.

This call came to me on a rainy fall evening, after dinner, before the little girls were going to bed. The city dispatch lady told me I was needed south of town. It was in a mobile home park. She gave me a number.

My little rusty Hilux had new wiper blades, so I was doing great heading south. I had not asked any details, any name. Maybe that was because I was new to this and wanted to seem on solid ground. I knew my way in the rainy dark.

Or thought so. I turned into the entrance of the mobile home park and then started to wonder.

No numbers were visible, the cars half obstructed the graveled, muddy street between the single wides. Some had a light on, most just a slight glow from curtained windows. Some all dark here at 730 PM in the wet cool fall on the Palouse.

I kept going, expecting a city patrol car to be my clue. Down one line, around the dark turn at the bottom and back up another. Then the next loop. A lot of people lived here in this dense plot of sloping soil down by the creek. Over the coming years I would return here again. And again. I could tell all those stories now, but I need to find the scene.

On my third loop I saw the patrol car. The light shone from the newer single wide porch.

An officer stood there in the drizzle, probably wondering where the hell I was. Do all three loops to find the scene? Jezus.

I parked the Hilux behind a neighbor’s rig, since there really was no street parking. I shuffled to the slick steps and greeted the patrolman. “Detective Frye is inside.” He nodded to the door. I went through. The detective turned from some folks in the well-lit living room and ushered me back out into the drizzle.

Here, by the glaring 60-watt porch bulb he told me the story. We were on a slick 2×6 deck with a railing. This was a significant home improvement in this area.

“This is a bit long so you gotta stay with me on this.” He started.

The deceased is in the back bedroom, he went on. He gave me a name, and age, 26-year-old male. Maybe some trouble with drugs, no trafficking.  It seems there had been a confrontation this evening.

The deceased was recently married to a younger woman, maybe girl and they had just had their first child. This marriage had been forced by the father when the younger girl had become pregnant. It turns out our deceased’s wife was 17, probably 16 at the moment of conception. But she and the deceased seemed to be making a go of it.

I wondered if “the deceased” was going to be the litany of this story. But Detective Frye soon lapsed into calling him by his name. I appreciated he was trying to do the respectful thing.

But tonight, it seems another man had made a complaint to the father who had forced this marriage. It sounded like the dad was a real patriarch, though I never met him. Detective Frye told me I wouldn’t, since the old man was downtown at this moment giving his statement.

This evening the patriarch had received the complaint of another man, probably another patriarch, that his daughter, just 16 had been impregnated by “the deceased”. And there must be justice. The patriarch had agreed and had come to this single wide to confront his errant son to insist he make things right.

The young bride with the infant, and the patriarch’s wife, the mother of the deceased had witnessed the confrontation. The old man had insisted the son come with him to the police station to make a statement. Son had agreed, “I’ll do it Dad.” But he needed to go get his coat. He went into the back bedroom, and they all heard a shot. Dad checked, then called the cops. And so, we are here.

I’m getting drizzled on. Detective Frye has a hat. I ask, “So you think they are all telling the same story, old man and wife and mom?”

He nods.

“Let’s go look.”

I wipe my feet again on the welcome mat as the door is opened. I first go to the living room. An older woman is sitting by a young dark-haired woman with an infant in her arms. I introduce myself and tell them my purpose. The older woman looks at me with a glance of derision and the young woman doesn’t make eye contact. Coroners are rarely welcome.

We walk back down the narrow hall. The floor feels soft, like walking on a hay loft, or maybe a weak stage for some traveling troupe. It may hold up tons, but it gives with a good stomp.

The path to the bedroom goes past the bathroom. The door open and the light is on, white and clean. Detective Frye opens the bedroom door and moves to the side so I can go in.

All the floors are carpeted. But the springiness isn’t just the shag. It just feels soft. The strong odor of blood hits me. Warm blood is unmistakable. I had learned it early on in the operating room, but before, as a child I had toured our towns slaughterhouse. Seeing the rubber booted Mexicans handling the hanging carcasses, the pools of blood they waded in, had given me a strong reaction. And this smell is deep in my memory.

The red, pink splattering over all the white of the walls, the ceiling, the bedspread, the dresser almost came off as a design touch. But it was not consistent with the motif.

I turned from the wide dark red pool on the shag toward the crumpled body beyond. I didn’t want to go there just yet. I looked at some pictures on a dresser just inside the door.

Somebody had paid a photographer to enshrine the images. The dark-haired bride smiled but the skinny groom looked stiff, wan, strung out. There was another portrait with her holding the baby. He looked even more drawn, more quartered, more desperate, though grinning. And there were red splatters that masked the smiling family portrait.

That was all I would know of his face. For it was not present on his body. Few appreciate what a deer rifle does at close range to the human head.

He wore polyester pants and jacket, like he might have just gotten off work. He was lying on his front, back up at the foot of the bed. The red pool soaked the carpet from under him to the middle of the dresser. There was no way I could not step in it. I could see the butt of the rifle off to his left, the rest under him. I looked at Detective Frye. He winced; maybe like I was. I got closer, stepping into the red goo. There was going to be little room to turn him over between the foot of the white now splotched-pink fluffy queen bed and the dresser.

I bent over him. There was just the back of his scalp left. Two long shreds of skin hung from the back of his neck. The white ceiling above was stippled with red to a pink. In the center of the splotch was a dark hole where the jacketed round had left the single wide, through the acoustic ceiling tiles, then through the metal roof out into the wet night above.

“If you lift him up, I’ll clear the gun.”

I bent and grabbed his polyester jacket on the left and raised him as best I could. For some reason, maybe the blood made the floor feel more solid here. I pulled. The shreds of the back of his head drooped, and the movement made a sucking sound as the pool of blood beneath let him up. The detective pulled the bolt action rifle back and out.

It was then I looked ahead to a crib next to the bed. The flesh, the floppy mask of the skinny, scared young mans face laid there, looking up at me.

Somehow, the ballistics and trajectory brought the shards of the explosion here, to the crib. This shred had none of the worry, none of the sorrow in the portraits. It was just a flaccid, mobile mask, like someone might pull on for a masquerade party, with nothing behind it, just ready to fit the wearers face. It lay still in the white, small crib next to the big empty bed.

I said goodbye to the two women in the living room. Another derisive glare and another averted glance, and I was out onto the wet porch.

“Do we need an autopsy?” The detective asked. They always want an autopsy.

“No” I said. “I can call this.”

Cause of Death: Gunshot wound to the head.

Manner of Death: Suicide

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Dice

It had to come to this.

Abortion is just one facet of the procreation die (singular for dice).

Infertility is another. And for many, mostly women, procreation does become a dicey endeavor.

So now, with a righteous Alabama Supreme Court opinion, this discussion might actually come into the open.

Us medical professionals have found living in the gray area of personhood profitable. Some, though truthfully, it was just a few practitioners, made money performing abortions. Some might have found some moral duty therein, even though the Hippocratic oath forbids abortion.

The line for abortion used to be “quickening”. Read The Cider House Rules, and you’ll learn the meaning of the question asked of the young pregnant woman, “Are you quick?”

For when the growing fetus’ movement was felt, and that was the line called “quickening”, an abortion was not considered proper. Before becoming quick, it was her decision, mainly.

The law didn’t enter into it in colonial times. There was community shame and derision and family pressure, but the law stayed out of this realm.

But in the mid 1800’s the medical profession lobbied state legislatures to make abortion illegal. You see, midwives, lay health providers did this procedure, since medical professionals were forbidden by oath. And doctors got paid to deliver babies. Maybe I’m cynical, but “follow the money” is good advice when considering what laws get passed.

So, most states outlawed abortion. Then the US Supreme Court handed down the Roe Decision. The line drawn by those justices was “viability”. When the fetus can survive outside of the mother, it is no longer her choice. Before, it is.

Viability comes at about 24 weeks of gestation.

Quickening comes usually about 16-20 weeks. These lines when the control of the decision shifts was very similar.

But now that Roe is no longer the law, and we’re back to state legislatures arbitrating, not only ending a pregnancy, but the decision to try to start one might move into the hands of lawmakers, not mothers, or families.

Because there are some real issues with infertility care that might make one cringe. Might make one consider passing legislation.

Say a woman is young and not ovulating. She and her partner want to conceive. The medical and pharmaceutical industries have wonderful drugs that can stimulate ovulation. They are inexpensive and convenient, though often unpleasant.

And now she gets pregnant. But she has a multiple.

The best chance for having a viable, healthy pregnancy is to deliver just one baby. The odds go down a bit with twins and drop off rapidly thereafter.

If she has five growing embryos, the odds are against any surviving. And the risk to the mother, should she choose to continue the pregnancy also goes up.

Selective reduction is the term used for this medical procedure. Some of the multiples are “reduced” so that some might survive.

A family wanted a baby. The doctor’s advice about the best odds for getting one might come down to sacrificing others.

Before Roe was overturned, the medical profession, mainly infertility specialists, had the freedom to discuss these very painful decisions with their patients. Not now. Especially under Idaho law. I’ll bet a lot of those OB Gyns fleeing our state practiced infertility care.

Where will Idaho infertility be treated?

And we haven’t even started talking about in vitro fertilization (IVF). That’s what got the Alabama Supreme Court going.

I could try to explain IVF in twenty words or less here, but let it just be said that technology may be miraculous. But with such power comes the need for wisdom.

Every medical and pharmaceutical intervention has odds of risk and cost or benefit. Do you want to roll the dice? If it’s an infertility gamble, you might have to leave Idaho.

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