PHOENIX — A 72-year-old Arizona man died days after falling on a sidewalk last year, with the hot surface burning 16% of his body.
An official with the Maricopa County Medical Examiner’s Office listed his cause of death as “complications of thermal injuries” because of prolonged exposure to elevated environmental temperatures on a hot surface.
But his death was not counted as a heat death.
The medical examiner’s office wrote that the man was considered a “transient,” meaning he was presumed to be homeless when he died.
A written report about his death said he was found in early July on a sidewalk outside a local motel in the direct sunlight in Mesa.
The high temperature that day was 118º.
The man was placed in hospice care and died 10 days later.
An ABC15 Investigation found there are dozens of cases where people like him died in hot temperatures, mainly outside, but their deaths were not counted in the 608 total people who were confirmed to have died of heat-related deaths in 2024.
In another case, ABC15 found a medical examiner dismissed heat as contributing to a man’s death in July 2024 because he was found covered with a blanket, which is not what one would expect for a death in a hot environment.
The medical examiner wrote, “he also had a credit card, shelter ID, and bus passes, which he could have used to escape hot environmental temperatures.”
The 29-year-old was found dead on a park bench on Van Buren Street. Officials listed that drugs contributed to his death.
TRACKING ‘PREVENTABLE’ DEATHS
Community advocate Stacey Champion said there needs to be a more standardized way of counting heat-related deaths in Arizona.
“People are dying really awful, preventable deaths,” she said.
Champion has been an advocate to make sure heat deaths do not go uncounted.
2024 was the first time in a decade when heat-related deaths declined, according to the county.
There were 37 fewer deaths in 2024 than in 2023, when a record of 645 people died in Maricopa County.
City and county leaders have used the decline in heat death numbers to show that the strategies they are taking are working.
“Through successful policymaking and with thanks to Mayor Gallego’s leadership, we were able to see a significant reduction in heat-related deaths,” said Phoenix Vice Mayor Ann O’Brien in a March news release.
Maricopa County leaders pushed out a news release earlier this year titled, "2024 Shows First Decline in Heat Deaths in a Decade."
WHO IS DYING?
The ABC15 Investigators reviewed hundreds of death records and found at least 50 cases that raise serious questions, including whether heat is being dismissed as a cause of death too often.
The Maricopa County Medical Examiner’s Office provides several lists of people who died in the county.
One accounts for the confirmed people who died from heat playing a role. The other list tracks every person who is considered “transient” when they died. It accounts for nearly 1,000 people who died in 2024.
In the transient list, there are hundreds of people who died outdoors, in hot temperatures that were not counted as heat-related deaths. ABC15 reviewed preliminary investigative reports that detail the circumstances around a person’s death, medical examiner reports, and toxicology reports.
The investigation found at least 50 cases in 2024 that experts and advocates say raise questions about why heat was not considered in the death.
“If I am thinking about where people may not notice people who just die, where is that going to be? It's going to be on the list of people who are already being forgotten by our society,” said Champion.
DEATH AFTER EVICTION
In another case ABC15 reviewed, a 75-year-old woman was found dead in a makeshift encampment after she was evicted just two weeks prior.
Phoenix police responded to her death in May 2024 and submitted it to the medical examiner’s office because there were concerns for heat-related circumstances, as temperatures reached 95º that day.
The preliminary sub manner of death was listed as “environment-heat associated.”
A medical examiner listed the final cause of death as cardiovascular disease with diabetes as a contributory factor. It made no mention of why heat was ruled out.
According to public records, the Maricopa County Medical Examiner’s Office considers 12 risk factors when investigating a heat-related death.
MEDICAL EXAMINER’S OPINIONS
The cause of death is ultimately an opinion of the medical examiner, according to Dr. Christina VandePol.
Dr. VandePol is a former coroner in Pennsylvania and tells ABC15 that counting heat deaths can be difficult. She reviewed some of the cases ABC15 found that raise questions as to why heat was not considered in some of these cases.
“All the ones that I looked at, I would have, based on the information I saw, I would have included heat as at least a contributory factor,” she said.
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Dr. VandePol said if she could not rule out heat, she would have noted it as a contributing factor.
“You can even use words like probable environmental heat exposure. You don't have to say it for sure,” Dr. VandePol said. “It's an opinion. You can say probably. You can say possibly. All of those are acceptable.”
The Maricopa County Medical Examiner’s Office declined an interview, but wrote in an email statement that their office is “a national model for how to rigorously investigate and evaluate heat-related deaths.”
The office added that forensic pathologists use their best medical judgment.
“Heat-related deaths are those where, in the forensic pathologist’s best medical judgment, exposure to high environmental heat either causes or contributes to the death,” a statement read, in part.
A county spokesperson also said the Maricopa County Department of Public Health “consistently messages that its heat surveillance does not account for every heat death or illness in the county.”
ABC15 asked the county what their methodology is for counting heat deaths, but they did not respond to that question.
Dr. VandePol said county officials could go back and re-look at some of these deaths, oftentimes called a “death review panel.”
“I think the time has come to start looking at environment-related, particularly heat-related deaths, and doing reviews like that,” said Dr. VandePol.
As for Champion, the community advocate, she calls these cases “hidden heat deaths.”
“I would say found heat deaths now, but, yeah, hidden heat deaths. Hidden heat deaths that no one has answered for,” she said.
MARICOPA COUNTY’S FULL STATEMENT:
“The accredited Maricopa County Office of the Medical Examiner (OME) is a national model for how to rigorously investigate and evaluate heat-related deaths. OME’s structured, consistent approach and skilled team bring tremendous value to our community, identifying trends that can reduce this tragic loss of life. Their insight comes from years of training and experience.
Each death is unique, and OME’s forensic pathologists consider all information collected before determining the primary and contributory medical causes of the death for the death certificate and authoring their Medical Examiner Reports. This includes the preliminary information gathered by medicolegal death investigators, medical record reviews, their direct observations during postmortem examinations, and the results of laboratory tests they order. Heat-related deaths are those where, in the forensic pathologist’s best medical judgment, exposure to high environmental heat either causes or contributes to the death. Those deaths trended downward in 2024 for the first time in a decade, and we are confident in that trend because OME methodology has remained consistent.
Maricopa County Department of Public Health consistently messages that its heat surveillance does not account for every heat death or illness in the county. The value in public health surveillance work is the evaluation of overall trends, and more specifically, the factors that tend to be involved in heat-related deaths. Knowing these trends and risk factors allow Maricopa County and its partners to put resources and programming where they will have the most impact in preventing heat deaths. Maricopa County’s primary focus is this life-saving work.”
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