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Did Heat Kill This Man?

Shortly after midnight on one of this summer's hottest nights, Jovanca Corlaic called the police because she was worried about her next-door neighbor.

She hadn't seen Jeffery Lynn Wenger for several days, which was unusual. She hadn't heard his Chihuahuas bark. And there was a bad smell coming from the little pink-painted concrete block house on East Garfield Street in south Scottsdale, Ariz.

Police found Wenger's badly decomposed body on his bedroom floor.

Corlaic says Wenger had no air-conditioning. In fact, he didn't have electricity or water. The city disconnected his utilities because he hadn't paid his bills. It wasn't because he was poor. Wenger inherited a substantial sum from his mother, says Corlaic, who was close to Dorothy Wenger and saw her will.

"I hate to say it, but he was very cheap," Corlaic says. "It's a tragic story. He didn't have to die."

Corlaic thinks Wenger died from the intense summer heat. He was 65 and Corlaic says he was in good health. But Phoenix temperatures had been topping out above 110 degrees at the time, with nighttime lows seldom below 90.

However, Wenger's death certificate doesn't mention heat exposure – the medical term is hyperthermia or heat stroke – as a cause or even a contributor to Wenger's demise.

The case provides a telling window on a problem that troubles many experts – the under-counting of heat-related deaths.

The problem is that when heat kills, it leaves no tell-tale mark on the body. Unless a heat-stroke victim dies during an attempted medical rescue, there will be no record of a body temperature of 104 degrees Fahrenheit or above, which is one criterion for heat stroke.

If an autopsy is done promptly, a forensic pathologist might diagnose heat stroke from chemical changes in the victim's blood and other body fluids. But often, as in Wenger's case, victims are discovered days later, and that evidence is lost.

"Heat stroke is a diagnosis of exclusion," says Dr. Ann Bucholtz, a medical examiner for Maricopa County, which includes Phoenix and Scottsdale.

That means a coroner ascribes death to heat stroke only if there's no other likely cause of death and all the circumstances point to high temperatures as the likely factor.

Bucholtz ruled that Wenger died of hypertensive cardiovascular disease – heart failure caused by high blood pressure. Complicating the picture is that people with heart disease are more vulnerable to heat stroke.

Why didn't the medical examiner put down heat stroke as a contributing cause of Wenger's death? After all, he had no air-conditioning during an extreme heat wave. And he had no water.

Bucholtz points out that Wenger had been without air-conditioning for some time, so she assumed that his body had acclimated to the heat. If his air-conditioning had gone on the fritz suddenly before his death, it would have been a different story.

Second, Bucholtz says Wenger did have bottled fluids in his house, even though the water was turned off.

The medical examiner acknowledges that she's on the conservative side when it comes to ascribing death or heat stroke unless there's strong evidence for it.

"That's going to vary person to person and office to office," she says.

Bucholtz agrees that heat-related deaths may be under-counted. That poses a dilemma for public health officials, because they don't know the size of the problem and who it affects.

She says there's discussion within the Maricopa County medical examiner's office about whether to change methods or death certificates to reflect the contribution of heat stroke more accurately.

Last year, Maricopa County counted 85 heat-caused or heat-related deaths. By late July this year, such deaths totaled 12, with 48 more under investigation.

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Richard Knox
Since he joined NPR in 2000, Knox has covered a broad range of issues and events in public health, medicine, and science. His reports can be heard on NPR's Morning Edition, All Things Considered, Weekend Edition, Talk of the Nation, and newscasts.