Study finds homicidal poisoning rising, more likely in infants and elderly

Homicidal poisonings are rare but on the rise—and infants are the most common victims—according to a new University of Georgia study that aims to raise awareness of this often overlooked crime.

Greene Shepherd, clinical professor in the UGA College of Pharmacy, and recent graduate Brian Ferslew examined seven years of recent federal mortality data and identified 523 deaths due to homicidal poisoning—a figure that corresponds to a rate of 0.26 poisonings per million people. The study found that although poisonings account for less than one percent of all homicides, they appear to be on the rise. The study documented a low of 0.20 cases per million in 2000 and a high of 0.35 in 2004. In 2005, the last year for which data is available, the rate was 0.3 per million people.

“Homicidal poisoning is rare relative to a lot of other causes of death, but the numbers are trending higher,” said Shepherd, whose results appear in the May issue of the journal Clinical Toxicology. “We may never know the true incidence because some cases undoubtedly evade detection and classification.”

Shepherd is a former poison control center director who had heard several anecdotal accounts of homicidal poisonings but found very little data on their incidence. Because such data is a critical starting point for efforts to reduce the risk of poisonings, he and Ferslew began combing through data compiled by the National Center for Health Statistics.

While books and television dramas often portray homicidal poisoning as a premeditated crime committed against adults, the researchers found that infants are the most common victims. Children less than one year old are approximately nine times more likely to be victims than the general population, the study found. Shepherd said that rather than being premeditated acts, the majority of these poisonings are likely negligent homicides committed by parents or caretakers.

“Anyone who has been a new parent knows about the long hours and the stress of an inconsolable child,” Shepherd says. “In some cases people make bad decisions and try to sedate their children with medication or alcohol. I think there’s a role for pharmacists and other health care workers to better educate new parents about the inappropriateness of sedating newborns.”

Further analysis by race found that African-American infants—who are 21 times more likely to be victims than the general population—are most at risk. Shepherd said this increased risk among African Americans is “a tragic result of socioeconomic status,” as stressful situations and poor coping skills are more common in young parents lacking family support and economic stability.

The study found that older adults also had a significantly higher rate of poisoning than the general population. Older adults who require institutional or home care are particularly susceptible to abuse, Shepherd said, and are at risk of being administered excessive doses of sedatives or other medications.

The study also found that drugs, medications and other biological substances accounted for 65 percent of the poisonings during the 1999 to 2005 study period, while assault by gasses and vapor accounted for 28 percent of poisonings. The remaining seven percent of assaults involved other chemicals, corrosive substances or pesticides.

“Though rare, these crimes do happen,” Shepherd said. “Now that we’ve identified at-risk populations, we have the potential to raise awareness and possibly save lives.”

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Evaluation Shows Significant Improvement in Local Hospitals' Disaster Preparedness

U.S. hospitals are significantly better prepared for disasters and
public health emergencies now than they were in 2001, but much work
remains to be done, according to a University of Pittsburgh Medical
Center study.

The study by the university's Center for Biosecurity was released today
by the U.S. Department of Health and Human Services' Office of the
Assistant Secretary for Preparedness and Response (ASPR). The study was
produced under contract with the agency.

The center was charged with conducting an independent evaluation of the
HHS Hospital Preparedness Program and the program's impact on health
care preparedness for mass casualty disasters. The program was
established by the Pandemic and All-Hazards Preparedness Act of 2006
after the Sept. 11, 2001, terrorist attacks to improve hospitals'
preparedness for all types of disasters.

"Hospitals are the foundation of the local health care response to
man-made and natural disasters. Each community's success in responding
and recovering depends in no small part on how well prepared the local
hospital is to withstand and respond to disaster," said Dr. Craig
Vanderwagen, HHS assistant secretary for preparedness and response, and
a rear admiral in the U.S. Public Health Service. "The HHS Hospital
Preparedness Program (HPP) has continually worked with states and local
communities to bolster that planning and response capability across the
country."

The study evaluated the first five years of the program from 2002 to
2007. It found that the most useful indicators for measuring the
preparedness of hospitals are ability to surge to accommodate additional
patients during disasters, how well hospitals do in training their staff
for disasters and realistic exercises, and how well hospitals perform
during actual disasters.

Hospital senior leaders now actively support and participate in
preparedness activities, hospital emergency operations plans are more
comprehensive and better coordinated with community emergency plans and
local hazards, and disaster training has become more rigorous, the
report said.

As additional indicators of improvement, hospitals have stockpiled
emergency supplies and medicines, have improved communication systems
and conduct more frequent and higher quality disaster exercises than in
the past, the study said.

The study showed that HPP has been the catalyst for new health care
coalitions throughout the country. As a result, it said, many
communities can now respond more effectively to disasters. Through these
coalitions, hospitals are now working collaboratively on disaster
preparedness with other hospitals, public health departments and
emergency managers.

The report also found that health care planning for catastrophic
emergencies at the individual hospital level is still in the early
stages and that a large-scale emergency could "overwhelm the medical
capabilities of communities, regions or the entire country and require
drastic departures from customary health care practices." The report
concluded that bridging this gap would require significant changes in
the way health care is delivered.

"Hospitals have made tremendous improvements with the funding and
guidance the program provides, and we recognize that much remains to be
done for our nation to become fully prepared for catastrophic public
health and medical emergencies," Vanderwagen said. "Continual progress
requires a sustained commitment and partnership among all levels of
government, private industry and non-government organizations."

The study's findings are based on a year of research and analysis,
including interviews with 133 individuals involved with hospital
preparedness in every state and at local levels across the country.

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Study Focuses on Barriers to Successful Prisoner Re-Entry Into Atlanta Communities

One out of every 100 Americans is incarcerated. One in 13 adults in Georgia is either in jail or on probation and parole, and the state holds the fifth largest prison population in the nation.

Hundreds of prisoners are released and return to metro-Atlanta neighborhoods every month. For Emory's Office of University-Community Partnerships, which has worked with dozens of community groups, services organizations, policy makers and government leaders for nearly a decade, issues around incarceration are a big piece of the puzzle in developing strategies to build strong communities.

"In many ways, the success or recidivism of former inmates has a tremendous impact on the communities where they settle, but given the stigma attached, it hasn’t exactly been a cause championed by many. But, positive reentry is a necessity, not an option, when it comes to public safety, preserving families and the development and stability of neighborhoods," said assistant professor of political science Michael Leo Owens, coauthor of the study "Prisoner Reentry in Atlanta: Understanding the Challenges of Transition from Prison to Community."

The report was recently completed by OUCP, and its authors hope their findings spark conversation and action among government leaders, service providers and community organizations to address the challenges of facilitating the positive integration of former prisoners back into communities. In addition to Owens, an OUCP senior faculty fellow, the study was compiled by Michael Rich, OUCP executive director and associate professor of political science, Sam Marie Engle, OUCP senior director, and Moshe Haspel, OUCP's director of research and Evaluation.

The immensely detailed and comprehensive reentry report analyzes data showing where people go in metro-Atlanta when they get out of prison, what support services, such as job training, mental health and substance abuse counseling, are there for them, and the availability of affordable housing and jobs. OUCP's study is part of the Urban Institute's national Reentry Mapping Network, which covers a dozen metropolitan areas around the country.

The study tracked nearly 5,000 people released from state prisons into probation and parole in 2004 and 2005 (as provided by the Georgia Department of Corrections and Georgia State Board of Pardons and Paroles) who took up residence in the five core metro-Atlanta counties: Fulton, DeKalb, Gwinnett, Cobb and Clayton. About a fifth settled in the city of Atlanta. While the greatest concentration was in and around Atlanta neighborhoods, prisoner reentry affects the entire metro-area. More than 80 percent of the former prisoners were non-violent offenders.

Focus groups with former prisoners, service providers and faith-based and government organizations filled in the picture of what issues former prisoners and communities face. Surveys also provided insight on public attitudes toward former prisoners.

Outside of access to services, securing jobs and affordable housing posed the biggest challenges to successful reentry for ex-offenders.

Gaining employment was hindered by multiple obstacles: In addition to low levels of education and work experience, and the reluctance of employers to hire someone who has served time in prison, they also lacked the personal networks to help them identify and secure jobs. Those findings echoed the experiences of government and community-based reentry service providers.

However, "housing was identified as the most central issue and need people faced immediately upon their return or move to Atlanta," said Owens. "For those released from prison without obtaining a guaranteed bed at a transitional house or shelter, and possessing only their $25 in 'gate money,' finding a place to stay that was secure, decent and accessible was often impossible."

The study also found differences in the types of programs offered by secular agencies and faith-based groups but overall they were often not in the geographic area where they are needed most.

"One thing we heard again and again from service providers was: 'I wish I knew what everyone else was doing,'" says Engle. "We hope that an outcome of this study will be a stronger network and coordination to provide the services that are needed."

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